"Explore the progressivity and determinants of out-of-pocket healthcare payments in Zambia, analyzing data sources, methodology, and measures of socio-economic status. Learn about the implications for achieving Universal Health Coverage."
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Presentation Transcript
Progressivity and determinants of Out-of- Pocket Payments in Zambia Felix Mwenge & John Ataguba Health Economics Unit, University of Cape Town
Universal Health Coverage (UHC) has become a global policy objective Achieving UHC depends to a large extent on how health care is financed Most countries that have achieved UHC rely less on regressive financing mechanism (e.g. South Korea, Chile, Costa Rica) OOP is one of such financing mechanisms found to be regressive in most countries Most African countries still rely on OOP as a significant source of health financing This has important implications on the achievement of UHC
Data Sources & Characteristics Survey Name Year No. Of Households LCMS I 1998 16,000 LCMS III 2004 18,000 LCMS IV 2006 19,000
Measure of Socio-economic Status Equivalent household expenditure Composition of OOP payments Costs of medicines, fees to medical personnel (e.g. Doctor / Health Assistant / Midwife / Nurse / Dentist, etc), payments to hospital/health centre/surgery , fees to traditional healer Excluded health related expenses such as transport costs and patient care costs
Progressivity of OOP payments K = C G K = Kakwani index of progressivity C = Concentration index of OOP payments G= Gini index of equivalent expenditure If K = 0, OOP payments are proportional If K < 0, OOP payments are regressive If K > 0, OOP payments are progressive
Determinants of OOP payments (Logistic Regression) Dep variable = OOP payments (binary) Independent variables (hhsize, location, age_hh, sex_hh, ms_hh, ed_hh, SES) Determinants of size of OOP payments (Tobit Regression) Dep variable = OOP payments (continuous) Independent variables: (hhsize, location, age_hh, sex_hh, ms_hh, ed_hh, w_hh,SES)
Kakwani index of progressivity of OOP payments, 1998, 2004 and 2006 P-value (5% level of significance K Year Conclusion 1998 0.34 0.000 Progressive 2004 -0.85 0.2264 Proportional 2006 0.14 0.819 Proportional
Equity in health care payments requires that payments be progressive contributions should be made according to ability to pay Progressivity of OOP payments in 1998 could be due to concentration of payments among richer households compared to poor households This phenomenon is also common in countries where poor households cannot afford to pay OOP The results should be taken cautiously OOP payments where proportional in 2004 and 2006 o As a percentage of their total resources there was no difference in OOP contributions between rich and poor households
Living in rural area was significantly associated with less likelihood of incurring OOP in 2006. This could be due to abolition of user fees in all primary rural facilities in early 2006 Likelihood of spending OOP was high among richer compared to poorer households and larger households compared to smaller ones
OOP should be reconsidered as a means of paying for health care in Zambia if UHC is to be achieved More progressive payment mechanisms should be considered to achieve UHC Abolition of user fees should be extended to urban areas to achieve UHC
