Best international health practice requires that all people benefit equally from health care
services regardless of their socio-economic status and that healthcare payments be based
on ability to pay. Although recent household surveys in Malawi show progress in a
number of health indicators population averages, many inequalities in health outcomes
still exist or are widening among households stratified by socioeconomic and
geographical location variables. Inequalities in out-of-pocket expenditures (OOPEs) for
healthcare and how they influence utilization of healthcare services are of particular
interest to policy makers as they ultimately affect overall health of households. The
rationale for this study is that analysis of inequities in healthcare between socioeconomic
groups can help to unmask intra-group and between groups' inequities hidden in national
population averages.
The study's three main papers examined equity in households' out-of-pocket healthcare
payments and utilization of medical care. The study adopted the widely used economic
frameworks and techniques developed by O'Donnell et al (2008) for analyzing health
equity using household data. These economic frameworks focus on the notion of equal
treatment for equal need and that payment for healthcare should be according to ability to
pay. The Malawi Integrated Household Survey 2(2005) (MIHS2) was the main dataset
used in the analysis. The MIHS2 is currently the only dataset that presents inequalities in
healthcare expenditures at the household level in Malawi. However, the MIHS2 report
does not examine the extent to which these inequalities are inequities.
It is in this context that the first study focused on assessing, first, the progressivity of
OOPEs for healthcare and second, the redistributive effect of OOPEs for healthcare as a
source of finance in the Malawi health system. The progressivity results indicate that
OOPEs for healthcare are relatively regressive in Malawi with the poor shouldering the
highest financial burden relative to their ability to pay. The study found no evidence of
redistributive effect of OOPEs on income inequalities in Malawi. The second study
focused on linking OOPEs to use of healthcare using the recommended two-part model
(Probit and OLS). The concentration indices were decomposed into contributing factors
after standardizing for health need factors, which include age, sex, self-assessed health,
chronic illness and disabilities. Probability of use of healthcare and OOPEs were both
found to be concentrated among the non-poor while the poor who have higher health
need have less use of healthcare. The last study assessed the socioeconomic factors
associated with horizontal equity in use of medical facilities and predicted use using
logistic regression. General medical facilities use was found to be more concentrated
among the non-poor despite the poor having a higher health need. The results showed no
significant inequalities in use of public medical facilities and self-treatment between the
poor and the non-poor.
Overall, inequalities in healthcare utilization and out-of-pocket healthcare expenditures in
Malawi are mainly influenced by socioeconomic factors, which are non-need factors than
health need factors. Inequalities due to non-need factors suggest presence of inequities,
which are avoidable and unjust. This study can help policy makers have a better
understanding of the possible effects of OOPEs and help in explaining the factors
contributing to inequities in medical care utilization in Malawi. Such information is
necessary so that highest priority should be given to the health problems or challenges
disproportionately affecting households with varying levels of socioeconomic privilege. / Graduation date: 2012
| Identifer | oai:union.ndltd.org:ORGSU/oai:ir.library.oregonstate.edu:1957/21885 |
| Date | 29 June 2011 |
| Creators | Mwandira, Ruth |
| Contributors | Chi, Chunhuei, Khanna, Sunnil, Smit, Ellen, MacTavish, Kate |
| Source Sets | Oregon State University |
| Language | English |
| Detected Language | English |
| Type | Thesis/Dissertation |
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