ArticleHealth economics review2020
Determinants of healthcare seeking and out-of-pocket expenditures in a "free" healthcare system: evidence from rural Malawi.
Article in Health economics review, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The burden of household out-of-pocket healthcare expenditures in Ethiopia: a systematic review and meta-analysis.International journal for equity in health · 2022Pooled it
- Association between the prevalence of overweight/obesity and dietary intake among mothers and children in urban and rural Malawi.Tropical medicine and health · 2026Article
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- The equity of health service utilization in less developed areas of China: evidence from Gansu Province.BMC public health · 2025Article
- Modeling determinants of accessibility for healthcare services in rural and urban areas of Dodoma, Tanzania.BMC public health · 2025Article
- Assessing the determinants of out-of-pocket health expenditures among Cambodian households in informal employment using survey data.International journal for equity in health · 2025Article
- Socioeconomic inequality in financial hardship in accessing quality healthcare services in Ethiopia: a community-based cross-sectional study.Frontiers in public health · 2025Article
- Ten years of ear, nose and throat (ENT) services in Southern Africa: a scoping review.Global health action · 2024Article
- Improving health-seeking behaviours of older adults in urban Africa: A holistic approach and strategic initiatives.Journal of global health · 2024Article
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- Experiences and practices of traditional healers on snakebite treatment and prevention in rural Malawi.PLoS neglected tropical diseases · 2023Article
- A cross-sectional analysis of the impact of health insurance on the use of health care in Rwanda.Heliyon · 2023Article
- The burden of ocular morbidities among elderly patients visiting a district healthcare facility in Malawi: A retrospective study.Health science reports · 2023Article
- Starting at the community: Treatment-seeking pathways of children with suspected severe malaria in Uganda.PLOS global public health · 2023Article
- To What Extent Do Free Healthcare Policies and Performance-Based Financing Reduce Out-of-Pocket Expenditures for Outpatient services? Evidence From a Quasi-experimental Study in Burkina Faso.International journal of health policy and management · 2023Article
- Spatial disparities in impoverishing effects of out-of-pocket health payments in Malawi.Global health action · 2022Article
- Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study.BMC public health · 2022Review
- 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
Corrections and comments
- Erratum issued
Authors and funding
7 authors.
Funding
Abstract
backgroundMonitoring 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.
methodsOur 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.
resultsOur 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 (p
conclusionOur 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.
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