ArticlePloS one2019
Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis.Bulletin of the World Health Organization · 2022Pooled it
- Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review.PloS one · 2022Pooled it
- A qualitative study of stakeholders' perceptions towards the implementation of the National Health Insurance Scheme in Zambia: equity and financial sustainability in question.Health policy and planning · 2026Article
- Harnessing rural community savings groups for contribution collection in the Zambia national health insurance scheme: an analysis of community perspectives using the motivation and ability framework.BMC health services research · 2026Article
- Article
- The political economy of national health insurance schemes: evidence from Zambia.Health policy and planning · 2025Article
- Prevalence of mortality caused by injuries at Livingstone University Hospital, Zambia. A retrospective cross-sectional study.PloS one · 2025Article
- Consumer Financial Protection Versus Catastrophic Healthcare Expenditure in Zambia.Public health challenges · 2024Article
- Estimating the out-of-pocket health expenditure in patients under 5 years with severe malnutrition in Afghanistan in 2023: Findings from a cross-sectional study.Health science reports · 2024Article
- Catastrophic Health Expenditure among Iranian Households: Evidence from the COVID-19 Era.Medical journal of the Islamic Republic of Iran · 2024Article
- Impact of cash transfer programs on healthcare utilization and catastrophic health expenditures in rural Zambia: a cluster randomized controlled trial.Frontiers in health services · 2024Article
- Forgone healthcare for medically vulnerable groups during the pandemic era: experiences of family caregivers of young adults with substance use disorders in Zambia.Frontiers in public health · 2024Article
- Do Out-of-Pocket Payments for Care for Children under 5 Persist Even in a Context of Free Healthcare in Burkina Faso? Evidence from a Cross-Sectional Population-Based Survey.Healthcare (Basel, Switzerland) · 2023Article
- Review
- Universal health coverage and the poor: to what extent are health financing policies making a difference? Evidence from a benefit incidence analysis in Zambia.BMC public health · 2022Article
- Tracking malaria health disbursements by source in Zambia, 2009-2018: an economic modelling study.Cost effectiveness and resource allocation : C/E · 2022Article
- Household Economic Consequences of Rheumatic Heart Disease in Uganda.Frontiers in cardiovascular medicine · 2021Article
- User fee policies and women's empowerment: a systematic scoping review.BMC health services research · 2020Article
- Rapid Assessment of the Potential Paucity and Price Increases for Suggested Medicines and Protection Equipment for COVID-19 Across Developing Countries With a Particular Focus on Africa and the Implications.Frontiers in pharmacology · 2020Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite the removal of user fees on public primary healthcare in Zambia, prior studies suggest that out-of-pocket payments are still significant. However, we have little understanding of the extent to which out-of-pocket payments lead patients to hardship methods of financing out-of-pocket costs. This study analyses the prevalence and determinants of hardship financing arising from out-of-pocket payments in healthcare, using data from a nationally-representative household health expenditure survey conducted in 2014. We employ a sequential logistic regression model to examine the factors associated with the risk of hardship financing conditional on reporting an illness and an out-of-pocket expenditure. The results show that up to 11% of households who reported an illness had borrowed money, or sold items or asked a friend for help, or displaced other household consumption in order to pay for health care. The risk of hardship financing was higher among the poorest households, female headed-households and households who reside further from health facilities. Improvements in physical access and quality of public health services have the potential to reduce the incidence of hardship financing especially among the poorest.
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Registered trials
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