PMID- 32228634
OWN - NLM
STAT- MEDLINE
DCOM- 20210604
LR  - 20231113
IS  - 1472-698X (Electronic)
IS  - 1472-698X (Linking)
VI  - 20
IP  - 1
DP  - 2020 Mar 30
TI  - Assessing medical impoverishment and associated factors in health care in 
      Ethiopia.
PG  - 7
LID - 10.1186/s12914-020-00227-x [doi]
LID - 7
AB  - BACKGROUND: About 5% of the global population, predominantly in low- and 
      middle-income countries, is forced into poverty because of out-of-pocket (OOP) 
      health spending. In most countries in sub-Saharan Africa, the share of OOP health 
      spending in current health expenditure exceeds 35%, increasing the likelihood of 
      impoverishment. In Ethiopia, OOP payments remained high at 37% of current health 
      expenditure in 2016. This study assesses the impoverishment resulting from OOP 
      health spending in Ethiopia and the associated factors. METHODS: This paper uses 
      data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. 
      The HCES covered 10,368 rural and 17,664 urban households. OOP health spending 
      includes spending on various outpatient and inpatient services. Impoverishing 
      impact of OOP health spending was estimated by comparing poverty estimates before 
      and after OOP health spending. A probit model was used to assess factors that are 
      associated with impoverishment. RESULTS: Using the Ethiopian national poverty 
      line of Birr 3781 per person per year (equivalent to US$2.10 per day), OOP health 
      spending pushed about 1.19% of the population (i.e. over 957,169 individuals) 
      into poverty. At the regional level, impoverishment ranged between 2.35% in 
      Harari and 0.35% in Addis Ababa. Living in rural areas (highland, moderate, or 
      lowland) increased the likelihood of impoverishment compared to residing in an 
      urban area. Households headed by males and adults with formal education are less 
      likely to be impoverished by OOP health spending, compared to their counterparts. 
      CONCLUSION: In Ethiopia, OOP health spending impoverishes a significant number of 
      the population. Although the country had piloted and initiated many reforms, e.g. 
      the fee waiver system and community-based health insurance, a significant 
      proportion of the population still lacks financial protection. The estimates of 
      impoverishment from out-of-pocket payments reported in this paper do not consider 
      individuals that are already poor before paying out-of-pocket for health 
      services. It is important to note that this population may either face deepening 
      poverty or forgo healthcare services if a need arises. More is therefore required 
      to provide financial protection to achieve universal health coverage in Ethiopia, 
      where the informal sector is relatively large.
FAU - Obse, Amarech G
AU  - Obse AG
AD  - Health Economics Unit, School of Public Health and Family Medicine, Health 
      Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town, 
      7925, South Africa. Amarech.Obse@uct.ac.za.
FAU - Ataguba, John E
AU  - Ataguba JE
AD  - Health Economics Unit, School of Public Health and Family Medicine, Health 
      Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town, 
      7925, South Africa.
LA  - eng
GR  - 64800/National Research Foundation (South Africa)/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200330
PL  - England
TA  - BMC Int Health Hum Rights
JT  - BMC international health and human rights
JID - 101088678
SB  - IM
MH  - Adult
MH  - *Delivery of Health Care
MH  - Ethiopia
MH  - *Family Characteristics
MH  - Female
MH  - *Health Care Reform
MH  - Health Expenditures/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Poverty/*statistics & numerical data
MH  - Rural Population/statistics & numerical data
MH  - Surveys and Questionnaires
PMC - PMC7106681
OTO - NOTNLM
OT  - Ethiopia
OT  - Financial protection
OT  - Impoverishment, out-of-pocket health spending
COIS- The authors declare that they have no competing interests.
EDAT- 2020/04/02 06:00
MHDA- 2021/06/05 06:00
PMCR- 2020/03/30
CRDT- 2020/04/02 06:00
PHST- 2019/07/31 00:00 [received]
PHST- 2020/03/19 00:00 [accepted]
PHST- 2020/04/02 06:00 [entrez]
PHST- 2020/04/02 06:00 [pubmed]
PHST- 2021/06/05 06:00 [medline]
PHST- 2020/03/30 00:00 [pmc-release]
AID - 10.1186/s12914-020-00227-x [pii]
AID - 227 [pii]
AID - 10.1186/s12914-020-00227-x [doi]
PST - epublish
SO  - BMC Int Health Hum Rights. 2020 Mar 30;20(1):7. doi: 10.1186/s12914-020-00227-x.