The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries

International Journal for Equity in Health

Systematic Review

Ivy Chumo¹  Blessing Mberu¹  John Smith²  Samuel Saidu²  Noemia Teixeira de Siqueira Filha³  Jinshuo Li³  Aishwarya Vidyasagaran³  Helen Elsey³  Md Imran Hossain Mithu⁴  Farzana Manzoor⁴  Abdul Awal⁴  Zahidul Quayyum⁴  Robinson Karuga⁵  Penelope A. Phillips-Howard⁶  Laura Rosu⁶  Rachel Tolhurst⁷  Eliud Kibuchi⁸  Surekha Garimella⁹  Varun Sai⁹  Vinodkumar Rao^1,10  Sumit Mazumdar^1,11 

[1] African Population and Health Research Center, Nairobi, Kenya;COMAHS: University of Sierra Leone, Freetown, Sierra Leone;Department of Health Sciences, University of York, York, UK;James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh;LVCT Health, Nairobi, Kenya;Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK;Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, UK;MRC/CSO Social &, University of Glasgow, Public Health Sciences Unit, Glasgow, UK;The George Institute for Global Health, New Delhi, India;The Society for Promotion of Area Resource Centres, Mumbai, India;University of York, Centre for Health Economics, York, UK;

关键词: Scoping review;    Informal settlements;    Slum;    Costs;    Catastrophic health expenditure;    Low;    Middle-income countries;    Health economics;   

DOI  :  10.1186/s12939-022-01804-3

 received in 2021-12-17, accepted in 2022-12-08,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs.MethodsThis scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs.ResultsWe identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality.ConclusionsOur findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.

【 授权许可】

CC BY   
© The Author(s) 2022

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