Does HIV Services Decentralization Protect against the Risk of Catastrophic Health Expenditures? Some Lessons from Cameroon

Sylvie Boyer (), Mohammad Abu‐zaineh (), Jérôme Blanche, Sandrine Loubière, Renée‐cécile Bonono, Jean‐paul Moatti and Bruno Ventelou ()
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Sylvie Boyer: SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale
Mohammad Abu‐zaineh: AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique
Jérôme Blanche: SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale, IRD [Occitanie] - Institut de Recherche pour le Développement - délégation Occitanie - IRD - Institut de Recherche pour le Développement
Sandrine Loubière: SPMC - Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants - AMU - Aix Marseille Université - APHM - Assistance Publique - Hôpitaux de Marseille
Bruno Ventelou: SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale

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Abstract: Objective. Scaling up antiretroviral treatment (ART) through decentralization of HIV care is increasingly recommended as a strategy toward ensuring equitable access to treatment. However, there have been hitherto few attempts to empirically examine the performance of this policy, and particularly its role in protecting against the risk of catastrophic health expenditures (CHE). This article therefore seeks to assess whether HIV care decentralization has a protective effect against the risk of CHE associated with HIV infection. Data Source and Study Design. We use primary data from the cross-sectional EVAL-ANRS 12-116 survey, conducted in 2006-2007 among a random sample of 3,151 HIV-infected outpatients followed up in 27 hospitals in Cameroon. Data Collection and Methods. Data collected contain sociodemographic, economic, and clinical information on patients as well as health care supply-related characteristics. We assess the determinants of CHE among the ART-treated patients using a hierarchical logistic model (n = 2,412), designed to adequately investigate the separate effects of patients and supply-related characteristics. Principal Findings. Expenditures for HIV care exceed 17 percent of household income for 50 percent of the study population. After adjusting for individual characteristics and technological level, decentralization of HIV services emerges as the main health system factor explaining interclass variance, with a protective effect on the risk of CHE. Conclusion. The findings suggest that HIV care decentralization is likely to enhance equity in access to ART. Decentralization appears, however, to be a necessary but insufficient condition to fully remove the risk of CHE, unless other innovative reforms in health financing are introduced.

Keywords: Catastrophic health expenditures decentralization multilevel modeling HIV treatment Cameroon; Catastrophic health expenditures; decentralization; multilevel modeling; HIV treatment; Cameroon (search for similar items in EconPapers)
Date: 2011-09-26
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Published in Health Services Research, 2011, 46, pp.2029 - 2056. ⟨10.1111/j.1475-6773.2011.01312.x⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05717689

DOI: 10.1111/j.1475-6773.2011.01312.x

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