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Estimating Catastrophic Health Expenditures from Household Surveys: Evidence from Living Standard Measurement Surveys (LSMS)-Integrated Surveys on Agriculture (ISA) from Sub-Saharan Africa

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  • Sarah Ssewanyana

    (Makerere University)

  • Ibrahim Kasirye

    (Makerere University)

Abstract

Background Out of pocket (OOP) payments for healthcare remain a significant health financing challenge in sub-Saharan Africa (SSA). Understanding the drivers and impacts of this financial health burden is both an economic and a public health priority. Objective This study examines how the burden of OOP health expenditures varies with different thresholds for financial catastrophe. Methods The analysis is based on Livings Standards Measurement Surveys (LSMS)-Integrated Surveys on Agriculture (ISA) for five SSA countries—Ethiopia, Malawi, Nigeria, Tanzania, and Uganda. We estimate the degree by which OOP payments as share of total household non-food expenditures exceed either the 15 or 25% threshold. Results For the countries considered, the severity of OOP payments is substantial—the average positive overshoot (beyond the 25% threshold) is above 10%, except for Nigeria. This reflects a higher percentage of OOP in total household health expenditures—compared to taxes and contributions—especially among the poor in these specific countries. Regarding sensitivity of distribution of catastrophic health expenditures, we find that households with low non-food expenditures are more likely to incur catastrophic payments with the exception for Uganda where catastrophic payments increase with the increase of non-food household expenditures. Conclusion The burden of catastrophic health expenditures remains large. In order to reduce this burden, public health expenditures need to be expanded as an alternative. This calls for renewed attention to expand public revenues as the most sustainable methods of financing health expenditures in Africa.

Suggested Citation

  • 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.
    • Handle: RePEc:spr:aphecp:v:18:y:2020:i:6:d:10.1007_s40258-020-00609-1
    DOI: 10.1007/s40258-020-00609-1
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    References listed on IDEAS

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    1. 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.
    2. World Health Organization & World Bank, 2017. "Tracking Universal Health Coverage," World Bank Publications - Books, The World Bank Group, number 29042.
    3. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    4. Kronenberg, Christoph & Barros, Pedro Pita, 2014. "Catastrophic healthcare expenditure – Drivers and protection: The Portuguese case," Health Policy, Elsevier, vol. 115(1), pages 44-51.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 28th December 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-12-28 12:00:00

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    Cited by:

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    2. Roosa Lambin & Milla Nyyssölä, 2022. "Exploring social policy trajectories in Mainland Tanzania: Driving for gender-inclusive development?," WIDER Working Paper Series wp-2022-38, World Institute for Development Economic Research (UNU-WIDER).
    3. Ryoko Sato, 2022. "Catastrophic health expenditure and its determinants among Nigerian households," International Journal of Health Economics and Management, Springer, vol. 22(4), pages 459-470, December.
    4. Roosa Lambin & Milla Nyyssölä, 2022. "Two decades of Tanzanian health policy: Examining policy developments and opportunities through a gender lens," WIDER Working Paper Series wp-2022-30, World Institute for Development Economic Research (UNU-WIDER).
    5. Magambo, Isaiah & Dikgang, Johane & Gelo, Dambala & Tregenna, Fiona, 2021. "Gold-Mining Pollution Exposure, Health Effects and Private Healthcare Expenditure in Tanzania," MPRA Paper 108800, University Library of Munich, Germany.
    6. Augustine Asante & Wilson S. K. Wasike & John E. Ataguba, 2020. "Health Financing in Sub-Saharan Africa: From Analytical Frameworks to Empirical Evaluation," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 743-746, December.
    7. Monica Ewomazino Akokuwebe & Erhabor Sunday Idemudia, 2022. "A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys," IJERPH, MDPI, vol. 19(3), pages 1-26, February.

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