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Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia

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  • Felix Masiye
  • Oliver Kaonga
  • Joses M Kirigia

Abstract

Background: Out-of-pocket payments in health care have been shown to impose significant burden on households in Sub-Saharan Africa, leading to constrained access to health care and impoverishment. In an effort to reduce the financial burden imposed on households by user fees, some countries in Sub-Saharan Africa have abolished user fees in the health sector. Zambia is one of few countries in Sub-Saharan Africa to abolish user fees in primary health care facilities with a view to alleviating financial burden of out-of-pocket payments among the poor. The main aim of this paper was to examine the extent and patterns of financial protection from fees following the decision to abolish user fees in public primary health facilities. Methods: Our analysis is based on a nationally representative health expenditure and utilization survey conducted in 2014. We calculated the incidence and intensity of catastrophic health expenditure based on households’ out-of-pocket payments during a visit as a percentage of total household consumption expenditure. We further show the intensity of the problem of catastrophic health expenditure (CHE) experienced by households. Results: Our analysis show that following the removal of user fees, a majority of patients who visited public health facilities benefitted from free care at the point of use. Further, seeking care at public primary health facilities is associated with a reduced likelihood of incurring CHE after controlling for economic wellbeing and other covariates. However, 10% of households are shown to suffer financial catastrophe as a result of out-of-pocket payments. Further, there is considerable inequality in the incidence of CHE whereby the poorest expenditure quintile experienced a much higher incidence. Conclusion: Despite the removal of user fees at primary health care level, CHE is high among the poorest sections of the population. This study also shows that cost of transportation is mainly responsible for limiting the protective effectiveness of user fee removal on CHE among particularly poorest households.

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  • Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    • Handle: RePEc:plo:pone00:0146508
    DOI: 10.1371/journal.pone.0146508
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    Cited by:

    1. Sarah Ssewanyana & Ibrahim Kasirye, 2020. "Estimating Catastrophic Health Expenditures from Household Surveys: Evidence from Living Standard Measurement Surveys (LSMS)-Integrated Surveys on Agriculture (ISA) from Sub-Saharan Africa," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 781-788, December.
    2. Haile, Kaleab & Tirivayi, Nyasha & Nillesen, Eleonora, 2019. "Climate shocks, coping responses and gender gap in human development," MERIT Working Papers 2019-052, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    3. Samuel López-López & Raúl del Pozo-Rubio & Marta Ortega-Ortega & Francisco Escribano-Sotos, 2021. "Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain," IJERPH, MDPI, vol. 18(3), pages 1-18, January.
    4. Steven F. Koch, 2017. "Does the Equivalence Scale Matter? Equivalence and Out-of-Pocket Payments," Working Papers 687, Economic Research Southern Africa.
    5. Atupele N Mulaga & Mphatso S Kamndaya & Salule J Masangwi, 2021. "Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-17, March.
    6. El-Shal, Amira & Cubi-Molla, Patricia & Jofre-Bonet, Mireia, 2021. "Are user fees in health care always evil? Evidence from family planning, maternal, and child health services," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 506-529.
    7. Oliver Kaonga & Charles Banda & Felix Masiye, 2019. "Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-14, April.
    8. Takondwa Mwase, 2021. "Health financing policy reforms for universal health coverage in eastern, central and southern Africa (ECSA)-health community region," Working Papers 179cherp, Centre for Health Economics, University of York.
    9. August Kuwawenaruwa & Michelle Remme & Gemini Mtei & Suzan Makawia & Stephen Maluka & Ntuli Kapologwe & Josephine Borghi, 2019. "Bank accounts for public primary health care facilities: Reflections on implementation from three districts in Tanzania," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 860-874, January.
    10. Aurélia Lépine & Mylène Lagarde & Alexis Le Nestour, 2018. "How effective and fair is user fee removal? Evidence from Zambia using a pooled synthetic control," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 493-508, March.
    11. Peter Binyaruka & Josephine Borghi, 2022. "An equity analysis on the household costs of accessing and utilising maternal and child health care services in Tanzania," Health Economics Review, Springer, vol. 12(1), pages 1-15, December.
    12. Kaonga, Oliver & Masiye, Felix & Kirigia, Joses Muthuri, 2022. "How viable is social health insurance for financing health in Zambia? Results from a national willingness to pay survey," Social Science & Medicine, Elsevier, vol. 305(C).
    13. Maria-Carmen García-Centeno & Román Mínguez-Salido & Raúl del Pozo-Rubio, 2021. "The Classification of Profiles of Financial Catastrophe Caused by Out-of-Pocket Payments: A Methodological Approach," Mathematics, MDPI, vol. 9(11), pages 1-20, May.
    14. Amber Hsiao & Verena Vogt & Wilm Quentin, 2019. "Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-12, August.
    15. Dell D. Saulnier & Christabel Saidi & Theresa Hambokoma & Joseph M. Zulu & Juliet Zulu & Felix Masiye, 2024. "Truth, humane treatment, and identity: perspectives on the legitimacy of the public and private health sectors during Covid in Zambia," Palgrave Communications, Palgrave Macmillan, vol. 11(1), pages 1-11, December.

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