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.
Catastrophic health expenditure
Costs
Health economics
Informal settlements
Low
Middle-income countries
Scoping review
Slum
Journal
International journal for equity in health
ISSN: 1475-9276
Titre abrégé: Int J Equity Health
Pays: England
ID NLM: 101147692
Informations de publication
Date de publication:
31 12 2022
31 12 2022
Historique:
received:
17
12
2021
accepted:
08
12
2022
entrez:
30
12
2022
pubmed:
31
12
2022
medline:
4
1
2023
Statut:
epublish
Résumé
The 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. This 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. We 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. Our 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.
Sections du résumé
BACKGROUND
The 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.
METHODS
This 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.
RESULTS
We 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.
CONCLUSIONS
Our 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.
Identifiants
pubmed: 36585704
doi: 10.1186/s12939-022-01804-3
pii: 10.1186/s12939-022-01804-3
pmc: PMC9805259
doi:
Types de publication
Systematic Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
191Subventions
Organisme : Medical Research Council
ID : MC_UU_00022/2
Pays : United Kingdom
Organisme : Chief Scientist Office
ID : SPHSU17
Pays : United Kingdom
Informations de copyright
© 2022. The Author(s).
Références
Health Policy Plan. 2017 Oct 1;32(8):1102-1110
pubmed: 28575415
Int J Inj Contr Saf Promot. 2019 Jun;26(2):129-136
pubmed: 30251588
J Urban Health. 2007 May;84(3 Suppl):i16-26
pubmed: 17356903
Southeast Asian J Trop Med Public Health. 2013 Jan;44(1):124-36
pubmed: 23682447
Soc Sci Med. 2018 Mar;201:136-147
pubmed: 29518580
PLoS One. 2018 Mar 16;13(3):e0194539
pubmed: 29547654
Int J Environ Res Public Health. 2019 Nov 28;16(23):
pubmed: 31795178
BMJ. 2018 Nov 29;363:k4905
pubmed: 30498010
Health Soc Care Community. 2019 Nov;27(6):1401-1420
pubmed: 31237386
Open Ophthalmol J. 2014 Dec 31;8:91-4
pubmed: 25674186
Int J Chron Obstruct Pulmon Dis. 2016 Oct 19;11:2625-2632
pubmed: 27799761
J Trop Pediatr. 2012 Jun;58(3):214-9
pubmed: 21908869
J Urban Health. 2021 Feb;98(1):111-129
pubmed: 33108601
Soc Sci Med. 2014 Feb;102:49-57
pubmed: 24565141
Health Econ. 2003 Nov;12(11):921-34
pubmed: 14601155
PLoS One. 2015 May 05;10(5):e0125878
pubmed: 25941805
AIDS Care. 2011 Dec;23(12):1602-8
pubmed: 21749222
Glob Health Action. 2018;11(1):1494897
pubmed: 30173603
JAMA Netw Open. 2020 Feb 5;3(2):e1920973
pubmed: 32049293
J Urban Health. 2016 Jun;93(3):526-37
pubmed: 27184570
Paediatr Int Child Health. 2017 Aug;37(3):181-187
pubmed: 27922342
Syst Rev. 2016 Feb 10;5:28
pubmed: 26864942
Bull World Health Organ. 2000;78(1):55-65
pubmed: 10686733
Trop Med Int Health. 2011 Oct;16(10):1334-41
pubmed: 21752164
PLoS One. 2013;8(2):e56873
pubmed: 23451102
Arch Gerontol Geriatr. 2018 Jan;74:55-61
pubmed: 28992514
Indian J Public Health. 2014 Apr-Jun;58(2):100-5
pubmed: 24820982
BMC Pregnancy Childbirth. 2010 Jul 30;10:38
pubmed: 20670456
Bull World Health Organ. 2012 Sep 1;90(9):664-71
pubmed: 22984311
Int J Equity Health. 2014 Apr 16;13:30
pubmed: 24739395
Natl Med J India. 2015 Jul-Aug;28(4):181-4
pubmed: 27132725
BMJ. 2002 Jan 5;324(7328):47
pubmed: 11797637
Annu Rev Public Health. 2000;21:543-67
pubmed: 10884964
BMJ Glob Health. 2019 Jun 16;4(3):e001501
pubmed: 31297245
BMC Public Health. 2018 Apr 16;18(1):501
pubmed: 29661233
Lancet. 2016 Aug 6;388(10044):596-605
pubmed: 27358253
J Urban Health. 2007 May;84(3 Suppl):i27-34
pubmed: 17387618
BMC Res Notes. 2019 Jan 15;12(1):25
pubmed: 30646940
Indian Pediatr. 2014 Jun;51(6):475-7
pubmed: 24986284
BMC Public Health. 2012 Nov 16;12:990
pubmed: 23158475
BMC Public Health. 2011 Mar 08;11:150
pubmed: 21385404
BMC Health Serv Res. 2007 Mar 15;7:43
pubmed: 17362506
Eur Respir J. 2014 Jun;43(6):1763-75
pubmed: 24525439
BMJ Open. 2013 Apr 03;3(4):
pubmed: 23558731
BMC Public Health. 2019 Jul 15;19(1):948
pubmed: 31307419
BMC Health Serv Res. 2012 Aug 28;12:285
pubmed: 22929107
Int J Equity Health. 2015 May 14;14:46
pubmed: 25971679
BMC Int Health Hum Rights. 2007 Mar 07;7:2
pubmed: 17343758
J Prev Med Hyg. 2020 Apr 02;61(1):E92-E97
pubmed: 32490274
Tuberc Res Treat. 2020 May 11;2020:3845694
pubmed: 32455013
Ann Intern Med. 2018 Oct 2;169(7):467-473
pubmed: 30178033
PLoS One. 2016 May 25;11(5):e0154563
pubmed: 27223811
Cad Saude Publica. 2018 Jul 23;34(7):e00104017
pubmed: 30043847
Front Public Health. 2019 Feb 15;7:24
pubmed: 30828573
Cien Saude Colet. 2013 Jan;18(1):115-28
pubmed: 23338502
Implement Sci. 2010 Sep 20;5:69
pubmed: 20854677
Value Health. 2013 Mar-Apr;16(2):231-50
pubmed: 23538175
Bull World Health Organ. 2014 Oct 1;92(10):760-7
pubmed: 25378730
Stud Fam Plann. 2009 Mar;40(1):39-50
pubmed: 19397184
PLoS One. 2018 Oct 12;13(10):e0204410
pubmed: 30312312
Public Health. 2019 Sep;174:145-153
pubmed: 31376684
Syst Rev. 2016 Dec 5;5(1):210
pubmed: 27919275
BMC Infect Dis. 2013 Nov 04;13:518
pubmed: 24188717
Indian J Public Health. 2017 Apr-Jun;61(2):67-73
pubmed: 28721954
Health Policy Plan. 2015 Mar;30 Suppl 1:i32-45
pubmed: 25759453
J Urban Health. 2011 Jun;88 Suppl 2:S185-99
pubmed: 21713552
BMJ Open. 2021 Jul 9;11(7):e045441
pubmed: 34244254
BMC Public Health. 2019 Dec 26;19(1):1735
pubmed: 31878911
Popul Dev Rev. 2015 Mar;41(1):59-84
pubmed: 26877568
Nagoya J Med Sci. 2015 Feb;77(1-2):203-12
pubmed: 25797985
Health Policy Plan. 2015 Jul;30(6):728-41
pubmed: 24966294
PLoS Med. 2014 Jul 15;11(7):e1001675
pubmed: 25025331
BMC Health Serv Res. 2014 Apr 15;14:173
pubmed: 24735729
PLoS One. 2020 Jun 15;15(6):e0233635
pubmed: 32542043
BMC Palliat Care. 2019 May 23;18(1):43
pubmed: 31122235
Int J Equity Health. 2015 Jun 09;14:53
pubmed: 26051372
BMC Health Serv Res. 2018 Jun 19;18(1):473
pubmed: 29921260
Int J Health Policy Manag. 2014 Apr 28;2(4):175-80
pubmed: 24847483
Eur Respir J. 2016 Nov;48(5):1396-1410
pubmed: 27660507
Health Econ. 2008 Dec;17(12):1393-412
pubmed: 18246595
BMJ Open. 2017 Sep 03;7(9):e017347
pubmed: 28871025
Cad Saude Publica. 2011;27 Suppl 2:S254-62
pubmed: 21789417
BMJ. 2020 Jan 16;368:l6890
pubmed: 31948937
Health Econ. 2007 Nov;16(11):1159-84
pubmed: 17311356
Lancet. 2003 Jul 12;362(9378):111-7
pubmed: 12867110
Int J Equity Health. 2016 Oct 13;15(1):169
pubmed: 27737663