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Shaltynov A, Jamedinova U, Semenova Y, Abenova M, Myssayev A. Inequalities in Out-of-Pocket Health Expenditure Measured Using Financing Incidence Analysis (FIA): A Systematic Review. Healthcare (Basel) 2024; 12:1051. [PMID: 38786461 PMCID: PMC11121301 DOI: 10.3390/healthcare12101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration.
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Affiliation(s)
- Askhat Shaltynov
- Epidemiology and Biostatistics Department, Semey Medical University, Semey 071400, Kazakhstan; (U.J.); (M.A.)
| | - Ulzhan Jamedinova
- Epidemiology and Biostatistics Department, Semey Medical University, Semey 071400, Kazakhstan; (U.J.); (M.A.)
| | - Yulia Semenova
- School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan;
| | - Madina Abenova
- Epidemiology and Biostatistics Department, Semey Medical University, Semey 071400, Kazakhstan; (U.J.); (M.A.)
| | - Ayan Myssayev
- Department of the Science and Human Resources, Ministry of Healthcare of the Republic of Kazakhstan, Astana 010000, Kazakhstan;
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Guerra S, Roope LS, Tsiachristas A. Assessing the relationship between coverage of essential health services and poverty levels in low- and middle-income countries. Health Policy Plan 2024; 39:156-167. [PMID: 38300510 PMCID: PMC10883664 DOI: 10.1093/heapol/czae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
Universal health coverage (UHC) aims to provide essential health services and financial protection to all. This study aimed to assess the relationship between the service coverage aspect of universal health coverage and poverty in low- and middle-income countries (LMICs). Using country-level data from 96 LMICs from 1990 to 2017, we employed fixed-effects and random-effects regressions to investigate the association of eight service coverage indicators (inpatient admissions; antenatal care; skilled birth attendance; full immunization; cervical and breast cancer screening rates; diarrhoea and acute respiratory infection treatment rates) with poverty headcount ratios and gaps at the $1.90, $3.20 and $5.50 poverty lines. Missing data were imputed using within-country linear interpolation or extrapolation. One-unit increases in seven service indicators (breast cancer screening being the only one with no significant associations) were associated with reduced poverty headcounts by 2.54, 2.46 and 1.81 percentage points at the $1.90, $3.20 and $5.50 lines, respectively. The corresponding reductions in poverty gaps were 0.99 ($1.90), 1.83 ($3.20) and 1.89 ($5.50) percentage points. Apart from cervical cancer screening, which was only significant in one poverty headcount model ($5.50 line), all other service indicators were significant in either the poverty headcount or gap models at both $1.90 and $3.20 poverty lines. In LMICs, higher service coverage rates are associated with lower incidence and intensity of poverty. Further research is warranted to identify the causal pathways and specific circumstances in which improved health services in LMICs might help to reduce poverty.
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Affiliation(s)
- Stefanny Guerra
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom
- Department of Population Health Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, United Kingdom
| | - Laurence Sj Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
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Musango L, Nundoochan A, Ramful Y, Kirigia JM. An assessment of the performance of the national health research system in Mauritius. BMC Health Serv Res 2023; 23:218. [PMID: 36879247 PMCID: PMC9990251 DOI: 10.1186/s12913-023-09208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The goal of universal health coverage (UHC) is that every individual has access to high-quality health services without running the consequences of financial hardship. The World health report 2013 "Research for universal health coverage" states a performant National Health Research Systems (NHRS) can contribute by providing solutions to challenges encountered in advancing towards UHC by 2030. Pang et al. define a NHRS as the people, institutions, and activities whose primary aim is to generate and promote utilization of high-quality knowledge that can be used to promote, restore, and/or maintain the health status of populations. The WHO Regional Committee for Africa (RC) adopted a resolution in 2015 urging member states to strengthen their NHRS to facilitate production and utilization of evidence in policy development, planning, product development, innovation, and decision-making. This study aimed to calculate NHRS barometer scores for Mauritius in 2020, identify the gaps in NHRS performance, and recommend interventions for boosting the Mauritius NHRS in the pursuit of UHC. METHODS The study used a cross-sectional survey design. A semi-structured NHRS questionnaire was administered and complemented with a review of documents archived in pertinent Mauritius Government Ministries, universities, research-oriented departments, and non-governmental organizations websites. The African NHRS barometer developed in 2016 for countries to monitor the RC resolution implementation was applied. The barometer consists of four NHRS functions (leadership and governance, developing and sustaining resources, producing and utilizing research, financing research for health [R4H]), and 17 sub-functions, e.g., existence of a national policy on research for health (R4H), presence of a Mauritius Research and Innovation Council (MRIC), existence of knowledge translation platform. RESULTS In 2020, Mauritius had an overall average NHRS barometer score of 60.84%. The four NHRS functions average indices were 50.0% for leadership and governance, 77.0% for developing and sustaining resources, 52.0% for producing and utilizing R4H, and 58.2% for financing R4H. CONCLUSION The performance of NHRS could be improved through the development of a national R4H policy, strategic plan, prioritized agenda, and national multi-stakeholder health research management forum. Furthermore, increased funding for the NHRS may nurture the human resources for health research capacities, hence the number of pertinent publications and health innovations.
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Affiliation(s)
- Laurent Musango
- World Health Organization, Country Office, Antananarivo, Madagascar
| | - Ajoy Nundoochan
- World Health Organization, Country Office, Port Louis, Mauritius.
| | - Yogendranath Ramful
- Independent Consultant (Previously Ministry of Health and Wellness), Port Louis, Mauritius
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Anjorin SS, Ayorinde AA, Abba MS, Mensah D, Okolie EA, Uthman OA, Oyebode OO. Equity of national publicly funded health insurance schemes under the universal health coverage agenda: a systematic review of studies conducted in Africa. J Public Health (Oxf) 2022; 44:900-909. [PMID: 34390345 DOI: 10.1093/pubmed/fdab316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The implementation of publicly funded health insurance schemes (PFHIS) is the major strategy to drive progress and achievement of universal health coverage (UHC) by 2030. We appraised evidence on the equity of insurance schemes across Africa. METHODS We conducted a systematic review of published studies that assessed equity in health insurance schemes implemented under the UHC agenda in Africa. Seven databases, Web of Science, Medline, CINAHL, Scopus, Cochrane Library, EMBASE and World Bank eLibrary, were searched; we operationalized the PROGRESS-Plus (place of residence; race/ethnicity/culture/language; occupation; gender/sex religion; education; socioeconomic status; social capital) equity framework to assess equity areas. RESULTS Forty-five studies met the inclusion criteria and were included in the study, in which 90% assessed equity by socioeconomic status. Evidence showed that rural residents, those self-employed or working in the informal sector, men, those with lower educational attainment, and the poor were less likely to be covered by health insurance schemes. Broadly, the insurance schemes, especially, community-based health insurance (CBI) schemes improved utilization by disadvantaged groups, however, the same groups were less likely to benefit from health services. CONCLUSIONS Evidence on equity of PFHIS is mixed, however, CBI schemes seem to offer more equitable coverage and utilization of essential health services in Africa.
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Affiliation(s)
- Seun S Anjorin
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
| | - Abimbola A Ayorinde
- NIHR Applied Research Collaboration West Midlands, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Mustapha S Abba
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
| | - Daniel Mensah
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
| | - Elvis A Okolie
- Department of Public Health, School of Health and Life Sciences, Teesside University, Tee Valley, Middlesbrough, North Yorkshire, TS1 3BX, UK
| | - Olalekan A Uthman
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
| | - Oyinlola O Oyebode
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hills Campus, Coventry CV4 7HL, UK
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Eze P, Lawani LO, Agu UJ, Amara LU, Okorie CA, Acharya Y. Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review. PLoS One 2022; 17:e0276266. [PMID: 36264930 PMCID: PMC9584403 DOI: 10.1371/journal.pone.0276266] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE A non-negligible proportion of sub-Saharan African (SSA) households experience catastrophic costs accessing healthcare. This study aimed to systematically review the existing evidence to identify factors associated with catastrophic health expenditure (CHE) incidence in the region. METHODS We searched PubMed, CINAHL, Scopus, CNKI, Africa Journal Online, SciELO, PsycINFO, and Web of Science, and supplemented these with search of grey literature, pre-publication server deposits, Google Scholar®, and citation tracking of included studies. We assessed methodological quality of included studies using the Appraisal tool for Cross-Sectional Studies for quantitative studies and the Critical Appraisal Skills Programme checklist for qualitative studies; and synthesized study findings according to the guidelines of the Economic and Social Research Council. RESULTS We identified 82 quantitative, 3 qualitative, and 4 mixed-methods studies involving 3,112,322 individuals in 650,297 households in 29 SSA countries. Overall, we identified 29 population-level and 38 disease-specific factors associated with CHE incidence in the region. Significant population-level CHE-associated factors were rural residence, poor socioeconomic status, absent health insurance, large household size, unemployed household head, advanced age (elderly), hospitalization, chronic illness, utilization of specialist healthcare, and utilization of private healthcare providers. Significant distinct disease-specific factors were disability in a household member for NCDs; severe malaria, blood transfusion, neonatal intensive care, and distant facilities for maternal and child health services; emergency surgery for surgery/trauma patients; and low CD4-count, HIV and TB co-infection, and extra-pulmonary TB for HIV/TB patients. CONCLUSIONS Multiple household and health system level factors need to be addressed to improve financial risk protection and healthcare access and utilization in SSA. PROTOCOL REGISTRATION PROSPERO CRD42021274830.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, United States of America
- * E-mail:
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Ujunwa Justina Agu
- Department of Community Medicine, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Linda Uzo Amara
- Department of Community Medicine, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Cassandra Anurika Okorie
- Department of Community Medicine, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Yubraj Acharya
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, United States of America
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Jung H, Lee KS. What Policy Approaches Were Effective in Reducing Catastrophic Health Expenditure? A Systematic Review of Studies from Multiple Countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:525-541. [PMID: 35285001 DOI: 10.1007/s40258-022-00727-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The United Nations set a goal for universal health coverage in all countries by 2030 and selected the catastrophic health expenditure (CHE) indicator as an assessment tool for this goal. Many countries have strived to reduce household CHE. However, no study has compared countries whose policies have had a remarkable effect on decreasing CHE. Therefore, the purpose of this systematic literature review is to find appropriate methods for measuring CHE that can help us to analyze the impact of health policies and identify countries whose health policies are most effective in reducing CHE. METHOD PubMed and Web of Science were searched. Studies that measured the incidence or intensity of CHE in multiple years were included. Two independent reviewers screened the literature, extracted the data, and analyzed the studies selected. Thirty-eight studies met the inclusion criteria for the review. We classified the selected research papers to random sampling and quasi-experimental studies. RESULTS We graphically presented the results of CHE incidence and intensity rates reported in the collected papers as a time series data set. Since most studies did not use sample weights, it was not easy to confirm whether the time series changes of CHE are significant. Therefore, we could find only two countries that had policy effects. Both countries established policies that focus on the poor. CONCLUSION There are so many studies that analyze CHE, but policies that are effective in reducing CHE are unknown. This study uses a systematic literature review methodology to determine effective policies by comparing CHE time series trends among countries. As a policy implication, it was found that because CHE is defined as the ratio of the ability to pay to medical expenses, a policy of differential medical expenses that is based on income level is effective.
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Affiliation(s)
- HyunWoo Jung
- Department of Health Administration, Graduate School·BK21 Graduate Program of Developing Glocal Experts in Health Policy and Management, Yonsei University, Changjo Hall, Room Number 419, Yonseidaegil 1, Gangwon-do, Wonju, South Korea
| | - Kwang-Soo Lee
- Department of Health Administration, Graduate School·BK21 Graduate Program of Developing Glocal Experts in Health Policy and Management, Yonsei University, Changjo Hall, Room Number 419, Yonseidaegil 1, Gangwon-do, Wonju, South Korea.
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Eze P, Lawani LO, Agu UJ, Acharya Y. Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis. Bull World Health Organ 2022; 100:337-351J. [PMID: 35521041 PMCID: PMC9047424 DOI: 10.2471/blt.21.287673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. Methods We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. We performed a meta-analysis using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. Findings We identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% (95% confidence interval, CI: 12.9-20.4; 50 datapoints; 462 151 households; I 2 = 99.9%) for a threshold of 10% of total household expenditure and 8.7% (95% CI: 7.2-10.3; 84 datapoints; 795 355 households; I 2 = 99.8%) for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Conclusion Although data on catastrophic health expenditure for some countries were sparse, the data available suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services. Stronger financial protection measures are needed.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, 504A Donald H. Ford Building, Pennsylvania State University, University Park, Pennsylvania, PA 16802, United States of America
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Ujunwa Justina Agu
- Department of Community Medicine, Enugu State University Teaching Hospital, Parklane, Nigeria
| | - Yubraj Acharya
- Department of Health Policy and Administration, 504A Donald H. Ford Building, Pennsylvania State University, University Park, Pennsylvania, PA 16802, United States of America
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Ly MS, Bassoum O, Faye A. Universal health insurance in Africa: a narrative review of the literature on institutional models. BMJ Glob Health 2022; 7:bmjgh-2021-008219. [PMID: 35483710 PMCID: PMC9052052 DOI: 10.1136/bmjgh-2021-008219] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/19/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Several African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals. Method This study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection). Results Ninety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa. Conclusion Public health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale.
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Affiliation(s)
- Mamadou Selly Ly
- Institut Santé et Développement (ISED), Cheikh Anta Diop University, Dakar, Senegal
| | - Oumar Bassoum
- Institut Santé et Développement (ISED), Cheikh Anta Diop University, Dakar, Senegal
| | - Adama Faye
- Institut Santé et Développement (ISED), Cheikh Anta Diop University, Dakar, Senegal
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Nundoochan A. Improving equity in the distribution and financing of health services in Mauritius, a small island state with deeply rooted welfare state standards. BMJ Glob Health 2021; 6:e006757. [PMID: 34952858 PMCID: PMC8710888 DOI: 10.1136/bmjgh-2021-006757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Ensuring benefits of free healthcare services are accessible to those in need is essential to achieve universal health coverage (UHC). Mauritius has sustained a welfare state over four decades with free health services in all public facilities. However, paradoxically, the national UHC service coverage index stood at only 63 in 2017. An assessment of who benefits from health interventions is, therefore, vital to shape future health financing strategies. METHODS The study applied benefit incidence analysis (BIA) to understand the distribution of healthcare utilisation and spending in comparison to income distribution. Also, a financial incidence analysis (FIA) was conducted to assess the progressivity of the health financing systems. Data from the national survey on household out-of-pocket (OOP) expenditure for health were used for the purpose of BIA and FIA. Concentration curves and concentration indices (CI) were nationally estimated and disaggregated to rural/urban levels. Kakwani index (KI) was calculated to assess the progressivity of private healthcare financing. RESULTS The CI for outpatient, inpatient and day care within the public health sector is estimated at -0.33, -0.14 and -0.14, respectively. Overall, CI in the public sector is -0.26. Benefit distribution in the private sector is pro-rich with CI of 0.27. Healthcare financing is regressive as demonstrated by a KI of -0.004, with the poorest population groups contributing a large share, in terms of taxes and OOP, to finance the health system. CONCLUSION The BIA posits that government spending on public healthcare has resulted in significant pro-poor services distribution. This is largely offset by pro-rich distribution in the private sector. Thus, implying health financing strategies must be reviewed to promote financial protection against catastrophic health payments and bolster efforts to improve UHC service coverage index and achieve UHC Target 3.8 under Sustainable Development Goal 3.
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Affiliation(s)
- Ajoy Nundoochan
- World Health Organization Country Office for Mauritius, Port-Louis, Mauritius
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Musango L, Nundoochan A, Van Wilder P, Kirigia JM. Monetary value of disability-adjusted life years lost from all causes in Mauritius in 2019. F1000Res 2021. [DOI: 10.12688/f1000research.28483.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The Republic of Mauritius had a total of 422,567 disability-adjusted life years (DALYs) from all causes in 2019. This study aimed to estimate the monetary value of DALYs lost in 2019 from all causes in Mauritius and those projected to be lost in 2030; and to estimate the monetary value of DALYs savings in 2030 if Mauritius were to attain the national targets related to five targets of the United Nations Sustainable Development Goal 3 on good health and well-being. Methods: The human capital approach was used to monetarily value DALYs lost from 157 causes in 2019. The monetary value of DALYs lost in 2019 from each cause was calculated from the product of net gross domestic product (GDP) per capita in Mauritius and the number of DALYs lost from a specific cause. The percentage reductions implied in the SDG3 targets were used to project the monetary values of DALYs expected in 2030. The potential savings equal the monetary value of DALYs lost in 2019 less the monetary value of DALYs expected in 2030. Results: The DALYs lost in 2019 had a total monetary value of Int$ 9.46 billion and a mean value of Int$ 22,389 per DALY. Of this amount, 84.2% resulted from non-communicable diseases; 8.7% from communicable, maternal, neonatal, and nutritional diseases; and 7.1% from injuries. Full attainment of national targets related to the five SDG3 targets would avert DALYs losses to the value of Int$ 2.4 billion. Conclusions: Diseases and injuries cause a significant annual DALYs loss with substantive monetary value. Fully achieving the five SDG3 targets could save Mauritius nearly 8% of its total GDP in 2019. To achieve such savings, Mauritius needs to strengthen further the national health system, other systems that tackle the social determinants of health, and the national health research system.
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Comparison of out-of-pocket expenditure and catastrophic health expenditure for severe disease by the health security system: based on end-stage renal disease in South Korea. Int J Equity Health 2021; 20:6. [PMID: 33407535 PMCID: PMC7789567 DOI: 10.1186/s12939-020-01311-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 10/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background Korea’s health security system named the National Health Insurance and Medical Aid has revolutionized the nation’s mandatory health insurance and continues to reduce excessive copayments. However, few studies have examined healthcare utilization and expenditure by the health security system for severe diseases. This study looked at reverse discrimination regarding end-stage renal disease by the National Health Insurance and Medical Aid. Methods A total of 305 subjects were diagnosed with end-stage renal disease in the Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify the healthcare utilization rate, out-of-pocket expenditure, and the prevalence of catastrophic expenditure. Mixed effect panel analysis was used to evaluate total out-of-pocket expenditure by the National Health Insurance and Medical Aid over a 6-year period. Results There were no significant differences in the healthcare utilization rate for emergency room visits, admissions, or outpatient department visits between the National Health Insurance and Medical Aid because these healthcare services were essential for individuals with serious diseases, such as end-stage renal disease. Meanwhile, each out-of-pocket expenditure for an admission and the outpatient department by the National Health Insurance was 2.6 and 3.1 times higher than that of Medical Aid (P < 0.05). The total out-of-pocket expenditure, including that for emergency room visits, admission, outpatient department visits, and prescribed drugs, was 2.9 times higher for the National Health Insurance than Medical Aid (P < 0.001). Over a 6-year period, in terms of total of out-of-pocket expenditure, subjects with the National Health Insurance spent more than those with Medical Aid (P < 0.01). If the total household income decile was less than the median and subjects were covered by the National Health Insurance, the catastrophic health expenditure rate was 92.2%, but it was only 58.8% for Medical Aid (P < 0.001). Conclusion Individuals with serious diseases, such as end-stage renal disease, can be faced with reverse discrimination depending on the type of insurance that is provided by the health security system. It is necessary to consider individuals who have National Health Insurance but are still poor.
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Musango L, Nundoochan A, Kirigia JM. The Discounted Money Value of Human Life Losses Associated With COVID-19 in Mauritius. Front Public Health 2020; 8:604394. [PMID: 33240837 PMCID: PMC7683431 DOI: 10.3389/fpubh.2020.604394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Mauritius along with other 12 countries in the African Region was identified at the early start of the COVID-19 pandemic as being at high risk due to high volume of international travel, high prevalence of non-communicable diseases and co-morbidities, high population density and significant share of population over 60 years (16%). The objective of this study was to estimate the total discounted money value of human life losses (TDMVCLMAURITIUS ) associated with COVID-19 in Mauritius. Methods: The human capital approach (HCA) was used to estimate the TDMVCLMAURITIUS of the 10 human life losses linked with COVID-19 in Mauritius as of 16 October 2020. The HCA model was estimated with the national life expectancy of 75.51 years and a discount rate of 3%. A sensitivity analysis was performed assuming (a) 5 and 10% discount rates, and (b) the average world life expectancy of 73.2 years, and the world highest life expectancy of 88.17 years. Results: The money value of human lives lost to COVID-19, at a discounted rate of 3%, had an estimated TDMVCLMAURITIUS of Int$ 3,120,689, and an average of Int$ 312,069 per human life lost. Approximately 74% of the TDMVCLMAURITIUS accrued to persons aged between 20 and 59 years. Reanalysis of the model with 5 and 10% discount rates, holding national life expectancy constant, reduced the TDMVCLMAURITIUS by 19.0 and 45.5%, respectively. Application of the average world life expectancy at 3% discount rate reduced TDMVCLMAURITIUS by 13%; and use of the world highest life expectancy at 3% discount rate increased TDMVCLMAURITIUS by 50%. Conclusions: The average discounted money value per human life loss associated with COVID-19 is 12-fold the per capita GDP for Mauritius. All measures implemented to prevent widespread community transmission of COVID-19 may have saved the country 837 human lives worth Int$258,080,991. This evidence, conjointly with human rights arguments, calls for increased investments to bridge the existing gaps for achieving universal health coverage by 2030.
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Affiliation(s)
- Laurent Musango
- World Health Organization, Country Office for Mauritius, Port Louis, Mauritius
| | - Ajoy Nundoochan
- World Health Organization, Country Office for Mauritius, Port Louis, Mauritius
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Nundoochan A. Improving public hospital efficiency and fiscal space implications: the case of Mauritius. Int J Equity Health 2020; 19:152. [PMID: 32887629 PMCID: PMC7473700 DOI: 10.1186/s12939-020-01262-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND General Government Health Expenditure (GGHE) in Mauritius accounted for only 10% of General Government Expenditure for the fiscal year 2018. This is less than the pledge taken under the Abuja 2001 Declaration to allocate at least 15% of national budget to the health sector. The latest National Health Accounts also urged for an expansion in the fiscal space for health. As public hospitals in Mauritius absorb 70% of GGHE, maximising returns of hospitals is essential to achieve Universal Health Coverage. More so, as Mauritius is bracing for its worst recession in 40 years in the aftermath of the COVID-19 pandemic public health financing will be heavily impacted. A thorough assessment of hospital efficiency and its implications on effective public health financing and fiscal space creation is, therefore, vital to inform ongoing health reform agenda. OBJECTIVES This paper aims to examine the trend in hospital technical efficiency over the period 2001-2017, to measure the elasticity of hospital output to changes in inputs variables and to assess the impact of improved hospital technical efficiency in terms of fiscal space creation. METHODS Annual health statistics released by the Ministry of Health and Wellness and national budget of the Ministry of Finance, Economic Planning and Development were the principal sources of data. Applying Stochastic Frontier Analysis, technical efficiency of public regional hospitals was estimated under Cobb-Douglas, Translog and Multi-output distance functions, using STATA 11. Hospital beds, doctors, nurses and non-medical staff were used as input variables. Output variable combined inpatients and outpatients seen at Accident Emergency, Sorted and Unsorted departments. Efficiency scores were used to determine potential efficiency savings and fiscal space creation. FINDINGS Mean technical efficiency scores, using the Cobb Douglas, Translog and Multi-output functions, were estimated at 0.83, 0.84 and 0.89, respectively. Nurses and beds are the most important factors in hospital production, as a 1% increase in the number of beds and nurses, result in an increase in hospital outputs by 0.73 and 0.51%, respectively. If hospitals are to increase their inputs by 1%, their outputs will increase by 1.16%. Hospital output process has an increasing return to scale. With technical efficiencies improving to scores of 0.95 and 1.0 in 2021-2022, potential savings and fiscal space creation at hospital level, would amount to MUR 633 million (US$ 16.2 million) and MUR 1161 million (US$ 29.6 million), respectively. CONCLUSION Fiscal space creation through full technical efficiency, is estimated to represent 8.9 and 9.2% of GGHE in fiscal year 2021-2022 and 2022-2023, respectively. This will allow without any restrictions the funding of the national response for HIV, vaccine preventable diseases as well as building a resilient health system to mitigate impact of emerging infectious diseases as experienced with COVID-19.
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Affiliation(s)
- Ajoy Nundoochan
- World Health Organization Country Office, Port Louis, Mauritius.
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Musango L, Timol M, Burhoo P, Shaikh F, Donnen P, Kirigia JM. Assessing health system challenges and opportunities for better noncommunicable disease outcomes: the case of Mauritius. BMC Health Serv Res 2020; 20:184. [PMID: 32143648 PMCID: PMC7059264 DOI: 10.1186/s12913-020-5039-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/26/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objectives of the study reported in this paper were: (a) to score the coverage of core NCD population-based interventions and individual services in Mauritius; (b) to analyse and score the presence of 15 common health system challenges that impede delivery of core NCD interventions and services in Mauritius; and (c) to provide policy recommendations for Mauritius to address health system barriers to delivery of NCD interventions and services. METHODS The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically scoring coverage of NCD interventions and assessing health system challenges for improving NCD outcomes. The assessment used qualitative research design approach. RESULTS Of the 24 core population-based interventions for addressing key NCD risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. The top five health system challenges hampering scale-up of coverage of population-based NCD interventions in Mauritius were inadequate interagency cooperation; limited application of explicit priority setting approaches; inadequate change management; sub-optimal distribution and mix human resources; insufficient population empowerment; and insufficient political commitment. The top five challenges had average scores of between 3.1 (interagency cooperation) and 2.4 (distribution and mix of human resources). The top five health system challenges constraining expansion in coverage of individual NCD services were limited integration of evidence into practice; limited use of explicit priority-setting approaches; inadequate application of information and technology solutions; insufficient population empowerment; and sub-optimal distribution and mix of human resources. The top five challenges for individual interventions had mean scores varying between 2.6 (integration of evidence into practice) and 1.7 (distribution and mix of human resources). CONCLUSIONS Mauritius needs to increase its domestic general government investments into the national health system and requisite multi-sectoral action to address the priority health system challenges with a view of bridging the existing gaps in coverage of NCD population-based interventions and individual services.
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Affiliation(s)
- Laurent Musango
- World Health Organization, Country Office for Mauritius, P.O. Box 1194, Port Louis, Mauritius.
| | - Maryam Timol
- Ministry of Health and Quality of Life (MOHQL), Port Louis, Mauritius
| | | | - Faisal Shaikh
- World Health Organization, Country Office for Mauritius, P.O. Box 1194, Port Louis, Mauritius
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