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Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia

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  • Oliver Kaonga
  • Charles Banda
  • Felix Masiye

Abstract

Despite the removal of user fees on public primary healthcare in Zambia, prior studies suggest that out-of-pocket payments are still significant. However, we have little understanding of the extent to which out-of-pocket payments lead patients to hardship methods of financing out-of-pocket costs. This study analyses the prevalence and determinants of hardship financing arising from out-of-pocket payments in healthcare, using data from a nationally-representative household health expenditure survey conducted in 2014. We employ a sequential logistic regression model to examine the factors associated with the risk of hardship financing conditional on reporting an illness and an out-of-pocket expenditure. The results show that up to 11% of households who reported an illness had borrowed money, or sold items or asked a friend for help, or displaced other household consumption in order to pay for health care. The risk of hardship financing was higher among the poorest households, female headed-households and households who reside further from health facilities. Improvements in physical access and quality of public health services have the potential to reduce the incidence of hardship financing especially among the poorest.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0214750
    DOI: 10.1371/journal.pone.0214750
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    1. 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).
    2. 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.

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