Publication: Prevalence of Catastrophic and Impoverishing Health Expenditures and Potential Protection against Financial Risks through Subsidies in Guinea
Loading...
Date
2023-03
ISSN
Published
2023-03
Editor(s)
Abstract
Universal health coverage initiatives in Guinea have been hampered by insufficient budget allocations and inefficiencies. Nevertheless, data on the extent of catastrophic and impoverishing health expenditures in Guinea are scarce and outdated. The objectives of this study were to (1) identify the drivers of total health expenditures, (2) estimate the prevalence of catastrophic and impoverishing health expenditures, and (3) estimate the drivers of and potential financial risk protection against catastrophic and impoverishing health expenditures through subsidies in Guinea. A retrospective cohort study was conducted using the 2018–19 Guinea Living Standards Measurement Study. All 41,449 individuals in the Study were eligible, but 15 individuals who lacked consumption expenditure data were excluded. Expenditure data were converted to 2019 international dollars. Based on means and medians, the primary drivers of total health expenditures were hospitalizations ($78 and $51, respectively) and medications ($72 and $61, respectively). Based on the distribution of total health expenditures by expenditure categories, the primary driver was medications (75 percent). The main driver of hospitalization expenditures was fever and 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 and 73 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 the operational aspects of the sector; (2) implement subsidy programs for rational use of medicines (notwithstanding the Bamako Initiative); (3) strengthen the National Malaria Control Program; and (4) establish an evidence-based operational financing strategy for universal health coverage.
Link to Data Set
Citation
“Porgo, Teegwendé Valérie; Magazi, Ibrahim; Djallo, Ezechiel Abouro. 2023. Prevalence of Catastrophic and Impoverishing Health Expenditures and Potential Protection against Financial Risks through Subsidies in Guinea. Policy Research Working Papers; 10353. © World Bank. http://hdl.handle.net/10986/39527 License: CC BY-NC 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication The Impoverishing Effect of Adverse Health Events : Evidence from the Western Balkans(World Bank, Washington, DC, 2007-12)This paper investigates the extent to which the health systems of the Western Balkans (Albania, Bosnia and Herzegovina, Montenegro, Serbia, and Kosovo) have succeeded in providing financial protection against adverse health events. The authors examine disparities in health status, healthcare utilization, and out-of-pocket payments for healthcare (including informal payments), and explore the impact of healthcare expenditures on household economic status and poverty. Methodologies include (i) generating a descriptive assessment of health and healthcare disparities across socioeconomic groups, (ii) measuring the incidence and intensity of catastrophic healthcare payments, (iii) examining the effect of out-of-pocket payments on poverty headcount and poverty gap measures, and (iv) running sets of country-specific probit regressions to model the relationship between health status, healthcare utilization, and poverty. On balance, the findings show that the impact of health expenditures on household economic wellbeing and poverty is most severe in Albania and Kosovo, while Montenegro is striking for the financial protection that the health system seems to provide. Data are drawn from Living Standards and Measurement Surveys.Publication Caribbean and Central American Partnership for Catastrophe Risk Insurance : Pooling Risk to Safeguard against Catastrophes Generated by Natural Events(Washington, DC, 2014-04)Countries in the Caribbean and Central America are highly vulnerable to the adverse effects associated with earthquakes, tropical cyclones, and other major hydro-meteorological events such as excessive rainfall. Aftermath of disasters typically place significant strain on the fiscal systems of affected countries. Consequently, ministers of the Central American integration system (SICA) and Caribbean community (CARICOM) countries have expressed a strong intention to collectively manage the disaster risk. By understanding the loss potential of disasters caused by natural events and the extent of public intervention in recovery and reconstruction efforts, governments can ascertain their respective contingent liabilities. Sovereign disaster risk financing and insurance can also safeguard against sudden macroeconomic shocks that negatively impact fiscal performance, and in turn, economic development. Caribbean and Central American governments are constrained in their ability to access quick liquidity to absorb fiscal shocks associated with natural hazard impacts because they have limited ability to create contingency funds, and limited capacity for external borrowing. The World Bank in partnership with the United States department of treasury assessed various options, which guided Ministers of Finance of Central America, Panama, and the Dominican Republic (COSEFIN) to identify the Caribbean catastrophe risk insurance facility (CCRIF) as the best option. The CCRIF provides cost-effective and fast-disbursing liquidity, and is an efficient way to finance a liquidity gap arising in the immediate aftermath of disaster.Publication Protection in Good and Bad Times? The Turkish Green Card Health Program(2012-08)This paper evaluates the equity and financial protection implications of the expansion of the Green Card (Yesil Kart) non-contributory health insurance program in Turkey during the growth years from 2003 to 2008. It also considers the program's protective impact during the economic crisis in 2009. The authors find that the rapid expansion of the program between 2003 and 2008 was highly progressive. It led to significant gains in coverage of the poor but offered limited financial protection as out-of-pocket expenditures even before the introduction of the program had been limited. Using a specialized welfare monitoring survey, fielded in 2009, the authors estimate the impact of the program on household level health care utilization during the first phase of the economic slowdown in Turkey. Using three different estimation techniques, they find that the Green Card program had a significantly positive impact on protecting health care utilization during the crisis.Publication Progress on Impoverishing Health Spending in 122 Countries(Elsevier, 2017-12-13)The goal of universal health coverage (UHC) requires that families who get needed health care do not suffer financial hardship as a result. This can be measured by instances of impoverishment, when a household's consumption including out-of-pocket spending on health is more than the poverty line but its consumption, excluding out-of-pocket spending, is less than the poverty line. This links UHC directly to the policy goal of reducing poverty. We find impoverishment due to out-of-pocket spending even in countries where the entire population is officially covered by a health insurance scheme or by national or subnational health services. Incidence is negatively correlated with the share of total health spending channelled through social security funds and other government agencies. Out-of-pocket spending on health can add to the poverty head count and the depth of poverty by diverting household spending from non-health budget items. The scale of such impoverishment varies between countries and depends on the poverty line but might in some low-income countries account for as much as four percentage points of the poverty head count. Increasing the share of total health expenditure that is prepaid, especially through taxes and mandatory contributions, can help reduce impoverishment.Publication Insurance against Climate Change : Financial Disaster Risk Management and Insurance Options for Climate Change Adaptation in Bulgaria(Washington, DC, 2014)Bulgaria is exposed to nearly all types of climate extremes, including floods, droughts, and others, as well as earthquakes. The combination of insurance products, early warning systems, information campaigns, infrastructure adaptation measures, and strict regulations can be very useful in tackling the negative climate change impacts. This note provides an overview of the insurance sector s contribution to climate change - related risk prevention and highlights some of Bulgaria s ongoing disaster risk management (DRM) efforts. The note aims to raise awareness and emphasize the role that financial disaster risk management (FDRM), including insurance, can have in climate change adaptation. Based on a desk review and preliminary in-country stakeholder consultations, the note s findings are meant to motivate new thinking and serve as an engagement tool for ongoing in-country discussions, as well to help identify analytical work to be carried out in the future. Based on the preliminary review of Bulgaria s specific context, several ideas are being put forward to be further explored in the ongoing discussions toward creating FDRM products to address the major natural disasters (in particular, floods, droughts, and earthquakes) and improving adaptation to climate change. Potential areas of analysis that can be further explored and, as such, plant a seed for future action can focus on promoting risk prevention and deploying insurance instruments, including issues around traditional risk management, technology innovation, compulsory disaster insurance, forecast insurance, and disaster insurance pools. The analysis which will assess the extent of vulnerability of the subjects covered by existing insurance products, can subsequently lead to the decisions on priority insurance products to be introduced in the future.
Users also downloaded
Showing related downloaded files
Publication Skill Development in India : The Vocational Education and Training System(Washington, DC, 2008-01)This paper stresses that despite the fact that India is a fast developing economy difficulties have led the Government to conclude that far more needs to be done to engender more employment opportunities for the majority of Indians, to enable them to participate in the benefits of growth and to contribute to that growth. To do this they must have education and training that equips them for the labor market. One of the sources of the skilled workforce is the vocational education and training system. However, the government realizes that the system is not being able to appropriately respond to the needs of the labor market. A key issue, then, is what reforms/interventions are needed to improve the effectiveness of the system. Answering that question is far from easy and this paper attempts to provide some options for doing so. On the one hand India faces the future with its changing realities; on the other hand it must deal with the nature of its established traditions and structures. This paper has laid out some key reforms that must be undertaken in different areas to make the vocational education and vocational training systems more responsive to the needs of the labor market. The reform agenda is fairly comprehensive and all the reforms cannot be implemented immediately. Given this, the paper has laid out some of the critical reforms that need to be undertaken in the short-run (first phase) followed by others that can be undertaken over a period of 2-3 years. The first phase focuses on reforms aimed at improving the quality and labor market relevance of the existing system, while the medium-term agenda also includes moving forward on mobilizing additional resources for the system, especially once the quality has improved. However the background work needed to undertake reforms in the medium-term should also commence immediately. These reforms should be treated as a package. If only some are instituted, while others are not, it is unlikely that the objective of developing a truly demand-responsive system will be effectively met.Publication Catastrophic Medical Expenditures(World Bank, Washington, DC, 2018-11)The ‘basic’ approach to 'catastrophic' medical expenses (where expenses are related to consumption or income) indicates whether expenses cause a large percentage reduction in living standards. By contrast, the 'ability-to-pay approach' (where expenses are related to consumption or income less actual expenses on nonmedical necessities or an allowance for them) does not indicate whether expenses are large enough to undermine a household’s ability to purchase nonmedical necessities. If the individual is a borrower after a health shock, the income-based ratio will exceed the consumption-based ratio, while the opposite is true when the individual continues to be a saver after a health shock. In the first case, both ratios will exceed Flores et al.'s more theoretically correct ratio, with the income-based ratio overestimating it by more. But if the individual is still a saver even after a health shock, the income-based ratio will overestimate Flores et al.'s ratio by less and may not overestimate it at all. A lifetime money metric utility approach can capture the lifetime consequences of coping with medical expenses. Under certain assumptions, but not otherwise, it and the Flores et al. approaches are identical, and both are operationalizable without data on how households finance their medical expenses.Publication Realizing the Full Potential of Social Safety Nets in Africa(Washington, DC: World Bank, 2018-07-17)Poverty has been declining in Sub-Saharan Africa, but millions are still poor or vulnerable. To address this ongoing and complex problem, all countries in the region have now deployed social safety net programs as part of their core development plans. The number of programs has skyrocketed since the mid-2000s, although many interventions are still modest in size. This notable shift in social policy reflects an embrace of the role that social safety nets can play in the fight against poverty and vulnerability, and more generally in building human capital and spurring economic growth. Realizing the Full Potential of Social Safety Nets in Africa provides evidence that positive impacts on equity, resilience, and opportunity are growing, and it is clear that these programs can be good investments. For the potential of social safety nets to be realized, however, they need to expand with smart technical and design choices. Beyond technical considerations, and at least as important, this book argues that a series of decisive shifts needs to occur in three critical spheres: political, institutional, and financial: First, to recognize the role of politics in offering opportunities for expansion and in guiding design and program choice; Second, to anchor safety net programs in strong institutional arrangements that facilitate their expansion and sustainability; And third, to build sustainable financing through greater efficiency, more varied and predictable resources, and shock-responsive resources. Ignoring these spheres may lead to technically sound, but practically impossible, choices and designs. A deliberate focus on these areas is essential if social safety nets are to be brought to scale and sustained at scale. Only then will their full potential and their contribution to the fight against poverty and vulnerability be realized.Publication The Impact of RSBY on Hospital Utilization and Out-of-Pocket Health Expenditure(World Bank, Washington, DC, 2012-12)In 2008, India launched Rashtriya Swasthya Bima Yojana (RSBY), a government subsidized health insurance scheme for the poor that covers secondary hospital care for Below Poverty Line (BPL) households. Designed to improve access to healthcare and reduce the financial burden of healthcare expenses, RSBY currently covers 32 million households. The authors exploit the phased rollout of RSBY to estimate the impact of the scheme in its early days on hospitalization rates and out-of-pocket health expenditure using a difference-in-differences approach with matching. We use secondary data from the National Sample Survey Organization conducted in 2009-10. We find that the scheme has led to a small decrease in out-of-pocket household outpatient expenditure and consequently total medical expenditure. The authors also find limited evidence of increase in the number of households that have had a hospitalization case though there are regional variations in the nature of impact. It is unclear whether the improved access to inpatient care is reducing outpatient expenses through decreased need for outpatient care or because some people or hospitals are colluding to convert outpatient treatment to inpatient to avail of the scheme. The authors suggest that additional evidence with a more recent data set allowing for more time for RSBY to display effects is needed to strengthen these early findings.Publication Ten Steps to a Results-Based Monitoring and Evaluation System : A Handbook for Development Practitioners(Washington, DC: World Bank, 2004)An effective state is essential to achieving socio-economic and sustainable development. With the advent of globalization, there are growing pressures on governments and organizations around the world to be more responsive to the demands of internal and external stakeholders for good governance, accountability and transparency, greater development effectiveness, and delivery of tangible results. Governments, parliaments, citizens, the private sector, Non-governmental Organizations (NGOs), civil society, international organizations, and donors are among the stakeholders interested in better performance. As demands for greater accountability and real results have increased, there is an attendant need for enhanced results-based monitoring and evaluation of policies, programs, and projects. This handbook provides a comprehensive ten-step model that will help guide development practitioners through the process of designing and building a results-based monitoring and evaluation system. These steps begin with a 'readiness assessment' and take the practitioner through the design, management, and importantly, the sustainability of such systems. The handbook describes each step in detail, the tasks needed to complete each one, and the tools available to help along the way.