Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from...

Area of Science:

• Health Economics
• Public Health Policy
• Sub-Saharan Africa Healthcare

Background:

• Out-of-pocket health payments burden households in Sub-Saharan Africa.
• User fee abolition aims to reduce financial hardship and improve access.
• Zambia removed user fees in primary care to alleviate poverty-related financial burdens.

Purpose of the Study:

• Examine financial protection from user fees after abolition in Zambia.
• Assess the extent and patterns of financial protection.
• Investigate the impact on catastrophic health expenditure.

Main Methods:

• Analysis of a 2014 national health expenditure and utilization survey.
• Calculation of incidence and intensity of catastrophic health expenditure (CHE).
• CHE defined as out-of-pocket payments exceeding a threshold of household consumption.

Main Results:

• Most patients at public facilities benefited from free care.
• Seeking care reduced the likelihood of CHE.
• However, 10% of households experienced CHE, disproportionately affecting the poorest quintile.

Conclusions:

• CHE remains high among the poorest despite user fee removal.
• Transportation costs significantly limit the effectiveness of user fee removal.
• Addressing non-fee barriers is crucial for comprehensive financial protection.