Wang, Wenjuan, Gheda Temsah, and Emily Carter. 2016. Levels and Determinants of Out-of-Pocket Health Expenditures in the Democratic Republic of the Congo, Liberia, Namibia, and Rwanda. DHS Analytical
Studies No. 59. Rockville, Maryland, USA: ICF International.
This study uses data from the Demographic and Health Surveys to explore the levels and determinants of out-of-pocket health expenditures in four African countries—Democratic Republic of the Congo (DRC), Liberia, Namibia, and Rwanda. The analysis assesses the use of inpatient and outpatient services and estimated out-of-pocket expenditures for the care received in the most recent visit. The highest use of health care services was in Namibia (18% for inpatient care and 41% for outpatient care), and the lowest was in DRC (4% for inpatient care and 7% for outpatient care). Health care was provided predominantly by public health facilities, with private providers being used more for outpatient than inpatient care. Average out-of-pocket spending for health care was highest in Liberia and lowest in Rwanda. Health expenditures were highly skewed to large amounts, and many people received care but did not pay for the services. Individuals from poorer households generally had less out-of-pocket expenditure than wealthier individuals. Health insurance coverage stands out as an important factor affecting the magnitude of out-of-pocket health expenditure in all four countries, but the results are mixed. In DRC and Rwanda health insurance coverage was associated with lower out-of-pocket expenditures for both inpatient and outpatient care services, while in Liberia and Namibia it was associated with higher out-of-pocket expenditures. Our results provide evidence of a need to expand health insurance coverage, especially in countries with low use of health services and high out-of-pocket health expenditures.