Inequality and Inequity in Outpatient Care Utilization in Ethiopia: A Decomposition Analysis of Ethiopian National Health Accounts.
Ethiopia
decomposition analysis
inequality
inequity
national health accounts
outpatient care utilization
Journal
ClinicoEconomics and outcomes research : CEOR
ISSN: 1178-6981
Titre abrégé: Clinicoecon Outcomes Res
Pays: New Zealand
ID NLM: 101560564
Informations de publication
Date de publication:
2021
2021
Historique:
received:
11
10
2020
accepted:
16
01
2021
entrez:
10
2
2021
pubmed:
11
2
2021
medline:
11
2
2021
Statut:
epublish
Résumé
Inequity in healthcare use is avoidable inequality, and it exists when there are differences in the use of healthcare after standardization of different needs among the population. In Ethiopia, wide variation and lower achievement exists in outpatient visit per person per year against the target to reach by 2020. Therefore, this study is aimed at measuring inequalities and inequities in outpatient care utilization in Ethiopia. The study utilized data from 2015/16 Ethiopian National Health Account survey. The analysis included a weighted sample of 42,460 individuals. Concentration curve and indices were used to measure inequality in outpatient care utilization. Deviations in the degree to which outpatient care was distributed according to need were measured by the horizontal inequity index. All statistical analyses were done using STATA version 14. In all analyses statistical significance was declared at a The outpatient care utilizations were found to be concentrated among the rich. The actual (C = 0.0335, 95% CI: 0.0298, 0.0431) and need predicted (C = 0.0157, 95% CI: 0.0117, 0.0413) utilizations were concentrated among the rich. The distributions of outpatient care in Ethiopians were pro-rich (rich-favoring). The decomposition analysis revealed that need factors were the main positive contributors to the inequality (23.6%) and non-need factors were among the negative contributors to the inequality (-48.4%). This study evidenced the presence of rich-favoring inequality and inequity in outpatient care utilization in Ethiopia. Therefore, there is a need to consider implementation strategies that focus on fairness in healthcare utilization.
Sections du résumé
BACKGROUND
BACKGROUND
Inequity in healthcare use is avoidable inequality, and it exists when there are differences in the use of healthcare after standardization of different needs among the population. In Ethiopia, wide variation and lower achievement exists in outpatient visit per person per year against the target to reach by 2020. Therefore, this study is aimed at measuring inequalities and inequities in outpatient care utilization in Ethiopia.
METHODS
METHODS
The study utilized data from 2015/16 Ethiopian National Health Account survey. The analysis included a weighted sample of 42,460 individuals. Concentration curve and indices were used to measure inequality in outpatient care utilization. Deviations in the degree to which outpatient care was distributed according to need were measured by the horizontal inequity index. All statistical analyses were done using STATA version 14. In all analyses statistical significance was declared at a
RESULTS
RESULTS
The outpatient care utilizations were found to be concentrated among the rich. The actual (C = 0.0335, 95% CI: 0.0298, 0.0431) and need predicted (C = 0.0157, 95% CI: 0.0117, 0.0413) utilizations were concentrated among the rich. The distributions of outpatient care in Ethiopians were pro-rich (rich-favoring). The decomposition analysis revealed that need factors were the main positive contributors to the inequality (23.6%) and non-need factors were among the negative contributors to the inequality (-48.4%).
CONCLUSION
CONCLUSIONS
This study evidenced the presence of rich-favoring inequality and inequity in outpatient care utilization in Ethiopia. Therefore, there is a need to consider implementation strategies that focus on fairness in healthcare utilization.
Identifiants
pubmed: 33564248
doi: 10.2147/CEOR.S286253
pii: 286253
pmc: PMC7866908
doi:
Types de publication
Journal Article
Langues
eng
Pagination
89-98Informations de copyright
© 2021 Kifle et al.
Déclaration de conflit d'intérêts
The authors declared that they have no conflicts of interest for this work.
Références
Int J Equity Health. 2017 Apr 21;16(1):67
pubmed: 28431502
Int J Equity Health. 2019 Oct 22;18(1):161
pubmed: 31640703
Health Policy Plan. 2017 Sep 1;32(7):969-979
pubmed: 28419286
Bull World Health Organ. 1999;77(7):537-43
pubmed: 10444876
Int J Equity Health. 2015 Jul 25;14:57
pubmed: 26204928
Int J Equity Health. 2017 Dec 04;16(1):210
pubmed: 29202843
Annu Rev Public Health. 2006;27:167-94
pubmed: 16533114
Int J Equity Health. 2014 Mar 19;13:24
pubmed: 24645826
Int J Environ Res Public Health. 2017 Jul 26;14(8):
pubmed: 28933772
Int J Equity Health. 2020 Sep 11;19(1):159
pubmed: 32917207
BMC Public Health. 2016 Dec 5;16(1):1226
pubmed: 27919238
J Res Health Sci. 2018 May 14;18(2):e00415
pubmed: 29784896
Cien Saude Colet. 2019 Jul 22;24(7):2745-2760
pubmed: 31340291
Int J Equity Health. 2017 Jun 19;16(1):105
pubmed: 28629358
Int J Health Serv. 1992;22(3):429-45
pubmed: 1644507
Health Policy Plan. 2016 Sep;31(7):817-24
pubmed: 26856362
Med Confl Surviv. 2012 Jul-Sep;28(3):219-46
pubmed: 23189589
J Res Health Sci. 2015 Winter;15(1):37-41
pubmed: 25821024
BMC Health Serv Res. 2010 Jul 23;10:217
pubmed: 20653970
Asia Pac J Public Health. 2015 May;27(4):429-38
pubmed: 25563350
J Health Popul Nutr. 2003 Sep;21(3):205-15
pubmed: 14717566
Milbank Mem Fund Q Health Soc. 1982 Winter;60(1):51-81
pubmed: 7038534
J Public Health Policy. 2011;32 Suppl 1:S102-23
pubmed: 21730985
Health Policy Plan. 2004 Sep;19(5):322-35
pubmed: 15310667
J Health Econ. 2009 Jan;28(1):73-90
pubmed: 18829124
Int J Equity Health. 2012 Jun 21;11:33
pubmed: 22720869