title: Assessing catastrophic and impoverishing effects of health care payments in Uganda.
abstract: BACKGROUND
  Direct out-of-pocket payments for health care are recognised as limiting access to health care services and also endangering the welfare of households. In Uganda, such payments comprise a large portion of total health financing. This study assesses the catastrophic and impoverishing impact of paying for health care out-of-pocket in Uganda.
  
  
  METHODS
  Using data from the Uganda National Household Surveys 2009/10, the catastrophic impact of out-of-pocket health care payments is defined using thresholds that vary with household income. The impoverishing effect of out-of-pocket health care payments is assessed using the Ugandan national poverty line and the World Bank poverty line ($1.25/day).
  
  
  RESULTS
  A high level and intensity of both financial catastrophe and impoverishment due to out-of-pocket payments are recorded. Using an initial threshold of 10% of household income, about 23% of Ugandan households face financial ruin. Based on both the $1.25/day and the Ugandan poverty lines, about 4% of the population are further impoverished by such payments. This represents a relative increase in poverty head count of 17.1% and 18.1% respectively.
  
  
  CONCLUSIONS
  The absence of financial protection in Uganda's health system calls for concerted action. Currently, out-of-pocket payments account for a large share of total health financing and there is no pooled prepayment system available. There is therefore a need to move towards mandatory prepayment. In this way, people could access the needed health services without any associated financial consequence.
authors.affiliation: HealthNet Consult, P.O. Box 35928, Kampala, Uganda. brendan.kwesiga@healthnetconsult.com.
authors.forename: Brendan
authors.initials: B
authors.lastname: Kwesiga
authors.affiliation: HealthNet Consult, P.O. Box 35928, Kampala, Uganda. charlotte@healthnetconsult.com.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Zikusooka
authors.affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa. john.ataguba@uct.ac.za.
authors.forename: John E
authors.initials: JE
authors.lastname: Ataguba
mesh_terms: D002388:Catastrophic Illness / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics*; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006296:Health Services / Q000191:economics; D006801:Humans; D008297:Male; D011203:Poverty / Q000191:economics; D011795:Surveys and Questionnaires; D014454:Uganda