Article type
Year
Abstract
Background: The growing urban population imposes additional challenges for health systems in developing countries. The lack of good quality public services and reliance on the private sector can result in catastrophic health expenditures (CHE).
Objectives: To document the economic impact of access to care and to identify inequalities in healthcare expenditures and CHE across urban populations.
Methods:This scoping review presents a narrative synthesis of cost studies conducted in urban areas. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and slums and non-slums studies. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We calculated the costs of accessing health care, concentration curves, index and incidence of CHE of acute, chronic and unspecified health conditions. We developed an evidence map to identify research gaps in the domains of the total number of studies, health interests and country. The review had a strong capacity strengthening element and all reviewers completed the Cochrane interactive learning modules on systematic reviews.
Results: We identified 64 studies for inclusion, the majority from South-East Asia (59%) and classified as city-wide (58%). None of the definitions of slums used covered all characteristics proposed by UN-Habitat. We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies.
Conclusions: Our findings indicated severe, but different patterns of the economic burden of accessing healthcare for slum dwellers and residents across cities. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand inequities in healthcare expenditure in rapidly expanding and evolving cities in developing countries.
Patient, public and/or healthcare consumer involvement: not applicable.
Objectives: To document the economic impact of access to care and to identify inequalities in healthcare expenditures and CHE across urban populations.
Methods:This scoping review presents a narrative synthesis of cost studies conducted in urban areas. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and slums and non-slums studies. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We calculated the costs of accessing health care, concentration curves, index and incidence of CHE of acute, chronic and unspecified health conditions. We developed an evidence map to identify research gaps in the domains of the total number of studies, health interests and country. The review had a strong capacity strengthening element and all reviewers completed the Cochrane interactive learning modules on systematic reviews.
Results: We identified 64 studies for inclusion, the majority from South-East Asia (59%) and classified as city-wide (58%). None of the definitions of slums used covered all characteristics proposed by UN-Habitat. We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies.
Conclusions: Our findings indicated severe, but different patterns of the economic burden of accessing healthcare for slum dwellers and residents across cities. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand inequities in healthcare expenditure in rapidly expanding and evolving cities in developing countries.
Patient, public and/or healthcare consumer involvement: not applicable.