The inequity in out-of-pocket expenditures for healthcare in Tajikistan: evidence and implications from a nationally representative survey.
OBJECTIVE
Out-of-pocket expenditures (OPE) for healthcare are a widespread and enduring phenomenon in post-communist countries. However, evidence regarding their effect on health equity is limited, especially in the low-income countries of Central Asia. With this in mind, the current paper presents the results of an analysis of the impact of OPE on equity in Tajikistan, one of the poorest transitional countries.


METHODS
Utilizing a sample from a nationally representative household survey, this paper presents a systematic examination of the effect of OPE on equity using concentration curve, quintile analysis and concentration indices. The impact was disaggregated by inpatient and outpatient services, and medication purchase. Further disaggregation was performed according to spatial dimensions, by types of providers, condition or disease, by place of medication purchase, and by type of facility and treatment received.


RESULTS
Overall, OPE in Tajikistan are equally distributed across the population, with the poorest and the wealthiest, in most cases, bearing a similar level of burden. However, the poor bear the heaviest burden in terms of expenditures for medication and other supplies in inpatient services. There is considerable spatial variation in the expenditures burden, with regional variation being more substantial than rural-urban variation. More importantly, the poor experience a larger proportion of burden with regard to expenditures in vital areas such as those of infectious diseases and maternal health.


CONCLUSIONS
While current economic constraints and the ongoing health sector reform in Tajikistan promote OPE for healthcare utilization, the lack of financial protection against the risk of these conditions should be of major concern to policy-makers. In particular, the problems of OPE, which have been found to place a higher burden on the poor, should be taken into consideration during healthcare reform in Tajikistan.
Habibov
Nazim N
NN
School of Social Work, University of Windsor, Chrysler Hall North, Windsor, ON, Canada. habibov@yahoo.com
D005382:Financing, Personal / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006306:Health Surveys / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000191:economics; D012959:Socioeconomic Factors; D013620:Tajikistan
D055553:Prescription Drugs