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Determinants of healthcare seeking and out-of-pocket expenditures in a “free” healthcare system: evidence from rural Malawi

Author

Listed:
  • Meike Irene Nakovics

    () (University of Heidelberg)

  • Stephan Brenner

    () (University of Heidelberg)

  • Grace Bongololo

    () (Research for Equity and Community Health (REACH) Trust)

  • Jobiba Chinkhumba

    () (University of Malawi College of Medicine)

  • Olivier Kalmus

    () (University of Heidelberg)

  • Gerald Leppert

    () (German Institute for Development Evaluation (DEval))

  • Manuela De Allegri

    () (University of Heidelberg)

Abstract

Background Monitoring financial protection is a key component in achieving Universal Health Coverage, even for health systems that grant their citizens access to care free-of-charge. Our study investigated out-of-pocket expenditure (OOPE) on curative healthcare services and their determinants in rural Malawi, a country that has consistently aimed at providing free healthcare services. Methods Our study used data from two consecutive rounds of a household survey conducted in 2012 and 2013 among 1639 households in three districts in rural Malawi. Given our explicit focus on OOPE for curative healthcare services, we relied on a Heckman selection model to account for the fact that relevant OOPE could only be observed for those who had sought care in the first place. Results Our sample included a total of 2740 illness episodes. Among the 1884 (68.75%) that had made use of curative healthcare services, 494 (26.22%) had incurred a positive healthcare expenditure, whose mean amounted to 678.45 MWK (equivalent to 2.72 USD). Our analysis revealed a significant positive association between the magnitude of OOPE and age 15–39 years (p = 0.022), household head (p = 0.037), suffering from a chronic illness (p = 0.019), illness duration (p = 0.014), hospitalization (p = 0.002), number of accompanying persons (p = 0.019), wealth quartiles (p2 = 0.018; p3 = 0.001; p4 = 0.002), and urban residency (p = 0.001). Conclusion Our findings indicate that a formal policy commitment to providing free healthcare services is not sufficient to guarantee widespread financial protection and that additional measures are needed to protect particularly vulnerable population groups.

Suggested Citation

  • Meike Irene Nakovics & Stephan Brenner & Grace Bongololo & Jobiba Chinkhumba & Olivier Kalmus & Gerald Leppert & Manuela De Allegri, 2020. "Determinants of healthcare seeking and out-of-pocket expenditures in a “free” healthcare system: evidence from rural Malawi," Health Economics Review, Springer, vol. 10(1), pages 1-12, December.
  • Handle: RePEc:spr:hecrev:v:10:y:2020:i:1:d:10.1186_s13561-020-00271-2
    DOI: 10.1186/s13561-020-00271-2
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    References listed on IDEAS

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    1. Booysen, Frikkie & van der Berg, Servaas & Burger, Ronelle & Maltitz, Michael von & Rand, Gideon du, 2008. "Using an Asset Index to Assess Trends in Poverty in Seven Sub-Saharan African Countries," World Development, Elsevier, vol. 36(6), pages 1113-1130, June.
    2. Xu, Ke & Evans, David B. & Kadama, Patrick & Nabyonga, Juliet & Ogwal, Peter Ogwang & Nabukhonzo, Pamela & Aguilar, Ana Mylena, 2006. "Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda," Social Science & Medicine, Elsevier, vol. 62(4), pages 866-876, February.
    3. Felix Khuluza & Lutz Heide, 2017. "Availability and affordability of antimalarial and antibiotic medicines in Malawi," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-15, April.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 8th June 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-06-08 11:00:08

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