Prevalence of Catastrophic and Impoverishing Health Expenditures and Potential Protectionagainst Financial Risks through Subsidies in Guinea

Universal health coverage initiatives in Guinea have been hampered by insufficient budgetallocations and inefficiencies. Nevertheless, data on the extent of catastrophic and impoverishing health expendituresin Guinea are scarce and outdated. The objectives of this study were to (1) identify the drivers of total healthexpenditures, (2) estimate the prevalence of catastrophic and impoverishing health expenditures, and (3) estimate thedrivers of and potential financial risk protection against catastrophic and impoverishing health expenditures throughsubsidies in Guinea. A retrospective cohort study was conducted using the 2018–19 Guinea Living StandardsMeasurement Study. All 41,449 individuals in the Study were eligible, but 15 individuals who lacked consumptionexpenditure data were excluded. Expenditure data were converted to 2019 international dollars. Based on means andmedians, the primary drivers of total health expenditures were hospitalizations ($78 and $51, respectively) andmedications ($72 and $61, respectively). Based on the distribution of total health expenditures by expenditurecategories, the primary driver was medications (75 percent). The main driver of hospitalization expenditures was feverand malaria (21 percent of hospitalization expenditures). The prevalences of catastrophic and health expenditures(equal to or greater than 10 percent threshold) and impoverishing health expenditures were 13 and 4 percent,respectively. Subsidizing medications would prevent 46 percent of the cases of catastrophic health expenditures and73 percent of the cases of impoverishing health expenditures. It is recommended that the Guinean government(1) strengthen the country’s pharmaceutical sector by reinforcing existing laws and regulations and theoperational aspects of the sector; (2) implement subsidy programs for rational use of medicines (notwithstanding theBamako Initiative); (3) strengthen the National Malaria Control Program; and (4) establish an evidence-basedoperational financing strategy for universal health coverage.