title: Financial hardship on the path to Universal Health Coverage in the Gulf States.
abstract: BACKGROUND
  Countries globally are pursuing universal health coverage to ensure better healthcare for their populations and prevent households from catastrophic expenditure. The countries of the Gulf Cooperation Council (GCC) have and continue to implement reforms to strengthen their health systems. A common theme between the countries is their pursuit of universal health coverage to provide access to necessary health care without exposing people to financial hardship.
  
  
  METHODS
  Using nationally representative data from the Global Findex study, we sought to analyze the hardship faced by individuals from four high-income countries in the GCC. We estimated the weighted proportion of individuals borrowing for medical reasons and those who are not able to obtain emergency funds. We further examined variations in these outcomes by key socioeconomic factors.
  
  
  RESULTS
  We found up to 11% of respondents borrowed money for medical purposes, double of that reported in other high-income countries. In contrast to affluent respondents, we found that respondents from deprived background were more likely to borrow money for medical purposes (adjusted odds ratio: 1.81, P<0.001) and expected to fail in obtaining emergency funds (adjusted odds ratio: 4.03, P<0.001).
  
  
  CONCLUSIONS
  In moving forward with their reforms, GCC countries should adopt a financing strategy that addresses the health needs of poorer groups in their pursuit of universal health coverage.
authors.affiliation: King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, United States; Department of Primary Care and Public Health, Imperial College London, United Kingdom. Electronic address: riyadh.alshamsan@gmail.com.
authors.forename: Riyadh
authors.initials: R
authors.lastname: Alshamsan
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, United States.
authors.forename: Hannah
authors.initials: H
authors.lastname: Leslie
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, United Kingdom.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, United States.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kruk
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D007730:Kuwait; D008297:Male; D008875:Middle Aged; D012529:Saudi Arabia; D012959:Socioeconomic Factors; D014479:United Arab Emirates; D019472:Universal Health Insurance / Q000191:economics*
keywords: Financial hardship; Health care reform; Health system financing