acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

High prevalence of childhood disease and low use of health facilities are reported for developing countries. In this study factors affecting the incidence of fever, cough and diarrhea and the factors predicting health facility use in rural DRC were analyzed. This study uses the data collected by the World Bank household survey in 2007 from eight health districts. In the districts, clusters were randomly selected for inclusion, and then a systematic selection of households was performed until the targeted number of children was reached. Data on health status of 5860 children during the previous two weeks were collected from 4838 households Bivariate analysis using Pearson chi-square was performed to identify potential determinants of childhood diseases. For cough and fever, multinomial logistic equation has been used to explain the choice of healthcare providers in comparison to the health center, the facility being promoted in DRC Percent of children who suffered from fever, cough and diarrhea were 46.2%, 33.3%, and 21.2% respectively. Age of the child, household size, and health district location were important in affecting the incidence of childhood diseases, while number of children under-five in the household and number of individuals per room were important in explaining the incidence of fever and diarrhea respectively. Health facility use was relatively low (47% for fever, and 35% for cough), but it was not as bad as reported by earlier studies. Income, education, cost of care, quality of care, type of symptom, hospital bed and geographic location were predictors of health facility use for fever and cough. The use of Oral Rehydration Salt for diarrhea was affected by income, age of the child and population density Children whose mothers believed cost of care was affordable were 52.2% and 43.8% less likely not to seek help (OR = 0.478 and 0.562) for fever and cough respectively. For hospital visit versus health center use, children from poorest households were 42.1% and 81.0% less likely to visit hospitals compared to the children from the least poor households (OR = 0.579 and 0.190). The findings may be used to encourage higher level of use of health centers / acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

Research objective. The purposes of this research are to discuss the patterns of catastrophic out-of-pocket payments, to explore the determinants of catastrophic out-of-pocket payments, and to find out the potential impact of introducing user fees for selective services, such as illness and antenatal care, on catastrophic out-of-pocket payments in rural households of Bangladesh Methodology. Data were collected from 5,400 households in selected rural areas of Bangladesh. Out-of-pocket healthcare payment is defined as 'catastrophic' if the ratio of annual per-capita household health expenditure to total annual per-capita household expenditure exceeds a specific pre-defined threshold level. Logit and Tobit models were used for identifying the variables affecting the incidence and intensity of catastrophic out-of-pocket payments. User fees were proposed to recover the cost of providing illness and antenatal care services. Price elasticity and inelasticity approaches with and without options of exemption policies were followed to find out the impact of introducing user fees on catastrophic out-of-pocket healthcare payments Principal findings. The incidence and intensity of catastrophic out-of-pocket payments, as expected, varied widely depending on threshold definition. Age of household head, employment status of household head, household size, per-capita expenditure, and proportion of children aged less than 5 years and reproductive women aged 15-45 years in the household were important in explaining the incidence and intensity of catastrophic out-of-pocket healthcare payments across households in the sample. Introduction of user fees in the health system increased the incidence and intensity of catastrophic out-of-pocket healthcare payments. Exemption policies decreased the incidence and intensity and protected poor households from catastrophic out-of-pocket healthcare payments Conclusions. The findings have policy implications to protect households from catastrophic out-of-pocket healthcare payments. Using the factors affecting the incidence and intensity of catastrophic out-of-pocket payments, it is possible to estimate the risk of catastrophic payment for each type of household. The probability of experiencing catastrophic payment can be used for targeting households for exemptions or for providing subsidized healthcare services. The results suggest that the incidence and intensity of catastrophic payments for healthcare can also be reduced significantly through adopting risk-pooling policies, such as community insurance programs, and enhancing tax collection / acase@tulane.edu