title: Out-of-pocket expenditure and its determinants in the context of private healthcare sector expansion in sub-Saharan Africa urban cities: evidence from household survey in Ouagadougou, Burkina Faso.
abstract: BACKGROUND
  Conventional wisdom suggests that out-of-pocket (OOP) expenditure reduces healthcare utilization. However, little is known about the expenditure borne in urban settings with the current development of the private health sector in sub-Saharan Africa. In an effort to update knowledge on medical expenditure, this study investigated the level and determinants of OOP among individuals reporting illness or injury in Ouagadougou, Burkina Faso and who either self-treated or received healthcare in either a private or public facility.
  
  
  METHODS
  A cross-sectional study was conducted with a representative sample of 1017 households (5638 individuals) between August and November 2011. Descriptive statistics and multivariate techniques including generalized estimating equations were used to analyze the data.
  
  
  RESULTS
  Among the surveyed sample, 29.6% (n = 1666) persons reported a sickness or injury. Public providers were the single most important providers of care (36.3%), whereas private and informal providers (i.e.: self-treatment, traditional healers) accounted for 29.8 and 34.0%, respectively. Almost universally (96%), households paid directly for care OOP. The average expenditure per episode of illness was 8404XOF (17.4USD) (median 3750XOF (7.8USD). The total expenditure was higher for those receiving care in private facilities compared to public ones [14,613.3XOF (30.3USD) vs. 8544.1XOF (17.7USD); p < 0.001], and the insured patients' bill almost tripled uninsured (p < 0.001). Finally, medication was the most expensive component of expenditure in both public and private facilities with a mean of 8022.1XOF (16.7USD) and 12,270.5 (25.5USD), respectively.
  
  
  CONCLUSIONS
  OOP was the principal payment mechanism of households. A significant difference in OOP was found between public and private provider users. Considering the importance of private healthcare in Burkina Faso, regulatory oversight is necessary. Furthermore, an extensive protection policy to shield households from catastrophic health expenditure is required.
authors.affiliation: École Nationale de Santé Publique, Ouagadougou, Burkina Faso. kone23ide@gmail.com.|Faculté Des Sciences Infirmières, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec, G1V 0A6, Canada. kone23ide@gmail.com.
authors.forename: Idrissa
authors.initials: I
authors.lastname: Beogo
authors.affiliation: International Health Program, National Yang-Ming University, 155, Sec 2, Linong St, 112, Taipei, Taiwan. Syhuang@ym.edu.tw.
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.affiliation: Faculté Des Sciences Infirmières, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec, G1V 0A6, Canada. marie-pierre.gagnon@fsi.ulaval.ca.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Gagnon
authors.affiliation: African Population and Health Research Center, APHRC Campus, 2nd Flore Manga Close, Off Kiwara Road, PO Box 10787-00100, Nairobi, Kenya. damendah@aphrc.org.
authors.forename: Djesika D
authors.initials: DD
authors.lastname: Amendah
mesh_terms: D000293:Adolescent; D000328:Adult; D002050:Burkina Faso; D002947:Cities; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D019981:Health Care Sector / Q000191:economics* / Q000941:ethics; D019538:Health Care Surveys; D005102:Health Expenditures / Q000941:ethics / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000941:ethics; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D017149:Private Sector / Q000191:economics* / Q000941:ethics; D012959:Socioeconomic Factors