@article{fdi:010080015,
  title = {{F}actors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of {PBF} : a cross-sectional study in {B}urkina {F}aso},
  author = {{B}eaug{\'e}, {Y}. and {R}idde, {V}al{\'e}ry and {B}onnet, {E}mmanuel and {S}ouleymane, {S}. and {K}uunibe, {N}. and {D}e {A}llegri, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {M}easuring progress towards financial risk protection for the poorest is essential within the framework of {U}niversal {H}ealth {C}overage. {T}he study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in {B}urkina {F}aso. {U}ltra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge. {M}ethods {W}e performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in {D}iebougou district. {M}ultivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. {T}he analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. {E}xcessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure. {R}esults {E}xemption card ownership was reported by 83.64% of the respondents. {W}ith an average of {FCFA} 23051.62 ({USD} 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. {T}he probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (beta = - 2.072, p = 0.00, {ME} = - 0.324; p = 0.000) and having an exemption card (beta = - 1.787, p = 0.025; {ME} = - 0.279, p = 0.014). {C}onclusions {U}ser fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. {O}ur results demonstrate the importance of free care and better implementation of existing exemption policies. {T}he ultra-poor's elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection.},
  keywords = {{O}ut-of-pocket expenditure ; {U}ltra-poor ; {T}argeting ; {P}erformance-based ; financing ; {B}urkina {F}aso ; {BURKINA} {FASO}},
  booktitle = {},
  journal = {{H}ealth {E}conomics {R}eview},
  volume = {10},
  numero = {1},
  pages = {36 [11 ]},
  ISSN = {2191-1991},
  year = {2020},
  DOI = {10.1186/s13561-020-00293-w},
  URL = {https://www.documentation.ird.fr/hor/fdi:010080015},
}