The Library
Inequity of healthcare access and use and catastrophic health spending in slum communities : a retrospective, cross-sectional survey in four countries
Tools
Improving Health in Slums Collaborative (Including: Aujla, Navneet, Chen, Yen-Fu, Gill, Paramjit, Griffiths, Frances, Harris, Bronwyn, Madan, Jason, Muir, Helen, Oyebode, Oyinlola, Pitidis, Vangelis, de Albuquerque, João Porto , Smith, Simon, Taylor, Celia A., Ulbrich, Philipp, Uthman, Olalekan A., Wilson, Ria and Yeboah, Godwin). (2021) Inequity of healthcare access and use and catastrophic health spending in slum communities : a retrospective, cross-sectional survey in four countries. BMJ Global Health, 6 (11). e007265. doi:10.1136/bmjgh-2021-007265 ISSN 2059-7908.
|
PDF
WRAP-Inequity-healthcare-access-use-catastrophic-health-spending-slum-cross-sectional-survey-four-countries-2021.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1966Kb) | Preview |
|
PDF
WRAP-Inequity-healthcare-access-use-catastrophic-health-spending-slum-cross-sectional-survey-four-countries-2021.pdf - Accepted Version Embargoed item. Restricted access to Repository staff only - Requires a PDF viewer. Download (146Kb) |
Official URL: https://doi.org/10.1136/bmjgh-2021-007265
Abstract
Introduction Tracking the progress of universal health coverage (UHC) is typically at a country level. However, country-averages may mask significant small-scale variation in indicators of access and use, which would have important implications for policy choice to achieve UHC.
Methods We conducted a retrospective cross-sectional household and individual-level survey in seven slum sites across Nigeria, Kenya, Bangladesh and Pakistan. We estimated the adjusted association between household capacity to pay and report healthcare need, use and spending. Catastrophic health expenditure was estimated by five different methods.
Results We surveyed 7002 households and 6856 adults. Gini coefficients were wide, ranging from 0.32 to 0.48 across the seven sites. The total spend of the top 10% of households was 4–47 times more per month than the bottom 10%. Households with the highest budgets were: more likely to report needing care (highest vs lowest third of distribution of budgets: +1 to +31 percentage points (pp) across sites), to spend more on healthcare (2.0 to 6.4 times higher), have more inpatient and outpatient visits per year in five sites (1.0 to 3.0 times more frequently), spend more on drugs per visit (1.1 to 2.2 times higher) and were more likely to consult with a doctor (1.0 to 2.4 times higher odds). Better-off households were generally more likely to experience catastrophic health expenditure when calculated according to four methods (−1 to +12 pp), but much less likely using a normative method (−60 to −80 pp).
Conclusions Slums have a very high degree of inequality of household budget that translates into inequities in the access to and use of healthcare. Evaluation of UHC and healthcare access interventions targeting these areas should consider distributional effects, although the standard measures may be unreliable.
Item Type: | Journal Article | ||||||
---|---|---|---|---|---|---|---|
Subjects: | H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine |
||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
Library of Congress Subject Headings (LCSH): | Health services accessibility , Medical care , Health care reform , Slums -- Health aspects, Medical care, Cost of | ||||||
Journal or Publication Title: | BMJ Global Health | ||||||
Publisher: | BMJ Publishing Group Ltd. | ||||||
ISSN: | 2059-7908 | ||||||
Official Date: | 29 November 2021 | ||||||
Dates: |
|
||||||
Volume: | 6 | ||||||
Number: | 11 | ||||||
Article Number: | e007265 | ||||||
DOI: | 10.1136/bmjgh-2021-007265 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Copyright Holders: | © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. | ||||||
Date of first compliant deposit: | 26 October 2021 | ||||||
Date of first compliant Open Access: | 30 November 2021 | ||||||
RIOXX Funder/Project Grant: |
|
||||||
Related URLs: |
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |
Downloads
Downloads per month over past year