Massito John, Hinju Gabriel
Department of Economics, The University of Dodoma, Dodoma, Tanzania.
Department of Geography and Economics, University College of Education, University of Dar es salaam, Dar es Salaam, Tanzania.
BMC Health Serv Res. 2025 May 10;25(1):677. doi: 10.1186/s12913-025-12783-w.
In most low-income countries (LICs), health is mainly financed by out-of-pocket (OOP) expenditures. However, it is claimed that this form of payment causes a massive burden on poor households. This study investigates the catastrophic impact of out-of-pocket health expenditure by estimating the levels, intensities and distribution of catastrophic health expenditure among households in Tanzania.
The study applied the Wagstaff & va-Doorslaer methodology to measure the incidence and intensity of catastrophic expenditure and the concentration index to measure the distribution of catastrophic expenditure using panel data 2020/2021. Then descriptive-analytical methods such as frequencies, means, and proportions were used to report the results.
The study found that 21.9% (19.1% from rural and 24.6% from urban) of the respondents reported visiting a healthcare facility within four weeks before the survey. Over 50% (53.5% from rural and 57.4% from urban) reported an incidence of illness or injury within the same period. The study also found that among those who utilised health care, about 7.1% (8.4% from rural and 5.7% from urban areas) experienced catastrophic health expenditures. The concentration index (-0.0175 and -0.0638) show that poor households are more likely to experience catastrophic health costs than rich households given the negative values of the indices. This phenomenon is particularly visible in Tanzania, where health insurance is still in its early stages of development.
We conclude that out-of-pocket health expenditures tend to lead to financial catastrophe for poor households, thereby exposing them to more poverty and forcing them to resort to coping mechanisms that compromise their welfare. This necessitates the development of new and reinforced existing systems to protect impoverished households against out-of-pocket and catastrophic healthcare costs.
在大多数低收入国家，医疗保健主要通过自费支出提供资金。然而，有人认为这种支付形式给贫困家庭带来了沉重负担。本研究通过估计坦桑尼亚家庭自费医疗支出的水平、强度和分布，调查自费医疗支出的灾难性影响。
该研究采用瓦格斯塔夫和瓦多斯拉尔方法来衡量灾难性支出的发生率和强度，并使用2020/2021年的面板数据，通过集中指数来衡量灾难性支出的分布。然后使用频率、均值和比例等描述性分析方法来报告结果。
研究发现，21.9%（农村地区为19.1%，城市地区为24.6%）的受访者报告在调查前四周内去过医疗机构。超过50%（农村地区为53.5%，城市地区为57.4%）的受访者报告在同一时期有疾病或受伤情况。研究还发现，在使用医疗服务的人群中，约7.1%（农村地区为8.4%，城市地区为5.7%）经历了灾难性医疗支出。集中指数（-0.0175和-0.0638）显示，鉴于指数为负值，贫困家庭比富裕家庭更有可能经历灾难性医疗费用。这种现象在坦桑尼亚尤为明显，该国的医疗保险仍处于发展初期。
我们得出结论，自费医疗支出往往会给贫困家庭带来经济灾难，从而使他们面临更多贫困，并迫使他们采取损害其福利的应对机制。这就需要开发新的并加强现有系统，以保护贫困家庭免受自费和灾难性医疗费用的影响。
