IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0212129.html
   My bibliography  Save this article

Financial risk protection at the bedside: How Ethiopian physicians try to minimize out-of-pocket health expenditures

Author

Listed:
  • Ingrid Miljeteig
  • Frehiwot Berhane Defaye
  • Paul Wakim
  • Dawit Neema Desalegn
  • Yemane Berhane
  • Ole Frithjof Norheim
  • Marion Danis

Abstract

Background: Out-of-pocket health expenditures can pose major financial risks, create access-barriers and drive patients and families into poverty. Little is known about physicians’ role in financial protection of patients and families at the bedside in low-income settings and how they perceive their roles and duties when treating patients in a health care system requiring high out-of-pocket costs. Objective: Assess physicians’ concerns regarding financial welfare of patients and their families and analyze physicians’ experiences in reducing catastrophic health expenditures for patients in Ethiopia. Method: A national survey was conducted among physicians at 49 public hospitals in six regions in Ethiopia. Descriptive statistics were used. Results: Totally 587 physicians responded (response rate 91%) and 565 filled the inclusion criteria. Health care costs driving people into financial crisis and poverty were witnessed by 82% of respondants, and 88% reported that costs for the patient are important when deciding to use or not use an intervention. Several strategies to save costs for patients were used: 37–79% of physicians were doing this daily or weekly through limiting prescription of drugs, limiting radiologic studies, ultrasound and lab tests, providing second best treatments, and avoiding admission or initiating early discharge. Overall, 75% of the physicians reported that ongoing and future costs to patients influenced their decisions to a greater extent than concerns for preserving hospital resources. Conclusion: In Ethiopia, a low-income country aiming to move towards universal health coverage, physicians view themselves as both stewards of public resources, patient advocates and financial protectors of patients and their families. Their high concern for family welfare should be acknowledged and the economic and ethical implications of this practice must be further explored.

Suggested Citation

  • Ingrid Miljeteig & Frehiwot Berhane Defaye & Paul Wakim & Dawit Neema Desalegn & Yemane Berhane & Ole Frithjof Norheim & Marion Danis, 2019. "Financial risk protection at the bedside: How Ethiopian physicians try to minimize out-of-pocket health expenditures," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-16, February.
  • Handle: RePEc:plo:pone00:0212129
    DOI: 10.1371/journal.pone.0212129
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212129
    Download Restriction: no

    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0212129&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pone.0212129?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Lydia Kapiriri & Douglas K. Martin, 2007. "Bedside Rationing by Health Practitioners: A Case Study in a Ugandan Hospital," Medical Decision Making, , vol. 27(1), pages 44-52, January.
    2. Kapiriri, Lydia & Norheim, Ole Frithjof & Martin, Douglas K., 2007. "Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda," Health Policy, Elsevier, vol. 82(1), pages 78-94, June.
    3. McKie, John & Richardson, Jeff, 2003. "The Rule of Rescue," Social Science & Medicine, Elsevier, vol. 56(12), pages 2407-2419, June.
    4. McIntyre, Diane & Thiede, Michael & Dahlgren, Göran & Whitehead, Margaret, 2006. "What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?," Social Science & Medicine, Elsevier, vol. 62(4), pages 858-865, February.
    5. Storeng, Katerini Tagmatarchi & Baggaley, Rebecca F. & Ganaba, Rasmané & Ouattara, Fatoumata & Akoum, Mélanie S. & Filippi, Véronique, 2008. "Paying the price: The cost and consequences of emergency obstetric care in Burkina Faso," Social Science & Medicine, Elsevier, vol. 66(3), pages 545-557, February.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. de Menil, Victoria & Knapp, Martin & McDaid, David & Njenga, Frank Gitau, 2014. "Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance," LSE Research Online Documents on Economics 56444, London School of Economics and Political Science, LSE Library.
    2. Sofaer, Neema & Kapiriri, Lydia & Atuyambe, Lynn M. & Otolok-Tanga, Erasmus & Norheim, Ole Frithjof, 2009. "Is the selection of patients for anti-retroviral treatment in Uganda fair?: A qualitative study," Health Policy, Elsevier, vol. 91(1), pages 33-42, June.
    3. Anshul Kastor & Sanjay K Mohanty, 2018. "Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-18, May.
    4. Salome A. Bukachi & Washington Onyango-Ouma & Jared Maaka Siso & Isaac K. Nyamongo & Joseph K. Mutai & Anna Karin Hurtig & Øystein Evjen Olsen & Jens Byskov, 2014. "Healthcare priority setting in Kenya: a gap analysis applying the accountability for reasonableness framework," International Journal of Health Planning and Management, Wiley Blackwell, vol. 29(4), pages 342-361, October.
    5. Xiaowei Yang & Jianmin Gao & Zhongliang Zhou & Jue Yan & Sha Lai & Yongjian Xu & Gang Chen, 2016. "Assessing the Effects of the New Cooperative Medical Scheme on Alleviating the Health Payment-Induced Poverty in Shaanxi Province, China," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-12, July.
    6. Robin Pope & Reinhard Selten & Johannes Kaiser & Sebastian Kube & Jürgen Hagen, 2012. "Exchange rate determination: a theory of the decisive role of central bank cooperation and conflict," International Economics and Economic Policy, Springer, vol. 9(1), pages 13-51, March.
    7. Kim, Chang-O & Joung, Won Oh, 2014. "Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: A quasi-experimental study," Social Science & Medicine, Elsevier, vol. 101(C), pages 28-35.
    8. Melberg, Andrea & Diallo, Abdoulaye Hama & Storeng, Katerini T. & Tylleskär, Thorkild & Moland, Karen Marie, 2018. "Policy, paperwork and ‘postographs’: Global indicators and maternity care documentation in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 215(C), pages 28-35.
    9. Richardson, Jeff & Sinha, Kompal & Iezzi, Angelo & Maxwell, Aimee, 2012. "Maximising health versus sharing: Measuring preferences for the allocation of the health budget," Social Science & Medicine, Elsevier, vol. 75(8), pages 1351-1361.
    10. Pavithra Harshani Warnakulasooriya & Kaushalya Kasturiaratchi, 2022. "The household economic cost of caregivers: children with congenital heart diseases attending to Pediatric Hospital, Sri Lanka," South Asia Economic Journal, Institute of Policy Studies of Sri Lanka, vol. 23(1), pages 52-60, March.
    11. Rebecca L. Thornton & Laurel E. Hatt & Erica M. Field & Mursaleena Islam & Freddy Solís Diaz & Martha Azucena González, 2010. "Social security health insurance for the informal sector in Nicaragua: a randomized evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 181-206, September.
    12. David Canning, 2006. "The Economics of HIV/AIDS in Low-Income Countries: The Case for Prevention," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 121-142, Summer.
    13. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    14. Patrick Sakdapolrak & Thomas Seyler & Christina Ergler, 2013. "Burden of direct and indirect costs of illness: Empirical findings from slum settlements in Chennai, South India," Progress in Development Studies, , vol. 13(2), pages 135-151, April.
    15. Nguyen, Kim Thuy & Hai Khuat, Oanh Thi & Ma, Shuangge & Pham, Duc Cuong & Hong Khuat, Giang Thi & Ruger, Jennifer Prah, 2012. "Coping with health care expenses among poor households: Evidence from a rural commune in Vietnam," Social Science & Medicine, Elsevier, vol. 74(5), pages 724-733.
    16. Benjamin M Hunter & Sean Harrison & Anayda Portela & Debra Bick, 2017. "The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-37, March.
    17. Ebaidalla Mahjoub Ebaidalla & Mohammed Elhaj Mustafa Ali, 2018. "Chronic Illness and Labor Market Participation in Arab Countries: Evidence from Egypt and Tunisia," Working Papers 1229, Economic Research Forum, revised 10 Oct 2018.
    18. Fang Ye & Haijun Wang & Dale Huntington & Hong Zhou & Yan Li & Fengzhi You & Jinhua Li & Wenlong Cui & Meiling Yao & Yan Wang & the study team for Economic Impact of Maternal Deaths in China, 2012. "The Immediate Economic Impact of Maternal Deaths on Rural Chinese Households," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-7, June.
    19. Kapiriri, Lydia & Norheim, Ole F. & Martin, Douglas K., 2009. "Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making?," Social Science & Medicine, Elsevier, vol. 68(4), pages 766-773, February.
    20. Omar Galárraga & Sandra Sosa-Rubí & Aarón Salinas-Rodríguez & Sergio Sesma-Vázquez, 2010. "Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(5), pages 437-447, October.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0212129. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.