Submission ID 131683
| Issue/Objective | Financial hardship from health spending remains a primary barrier to universal health coverage (UHC), yet nearly one in four people globally will still face health-related financial hardship by 2030. With development funding under pressure and domestic health budgets tightening, policymakers urgently need clear, actionable guidance on which interventions improve financial protection. However, no resources existed which outlined the full range of interventions that have been tried and tested for their effects on improving financial protection. To address this gap in tools which can support evidence-informed decision-making in this area, the UK's Foreign, Commonwealth and Development Office commissioned this research to examine: which policy choices or interventions are most or least effective in improving healthcare-related financial protection in LMICs? |
|---|---|
| Methodology/Approach | We conducted a rapid evidence review of studies published between 1999 and 2024, including primary research from LMICs reporting on financial protection outcomes. Study selection, data extraction, and quality appraisal followed systematic procedures. Using narrative synthesis methods, we examined 214 studies across 39 countries, categorising interventions by mechanism used to address financial protection and assessing their effects on out-of-pocket expenditure (OOPE), catastrophic health expenditure, impoverishment, service utilisation, and equity. |
| Results | Various interventions have been studied in LMICs for their effect on financial protection, including insurance-related interventions, demand-side and supply-side health system reforms, and increased access to essential medicines. Policies outside the health sector were understudied. No single intervention consistently ensured financial protection; however, the evidence highlights the value of multi-sectoral approaches that addressed underlying inequities and systemic barriers to affordable healthcare access. |
| Discussion/Conclusion | Effective strategies to ensure all can access high-quality, needed health care without experiencing financial hardship must address multiple, interconnected drivers of financial hardship, both within and beyond the health sector. Drawing on the evidence, we present a practical framework organised around reducing direct and indirect costs of accessing care; reducing overall poverty and financial vulnerability; and reducing the need for costly care by addressing social determinants of health. For policymakers and donors, this framework offers a tool for diagnosing gaps, designing multi-pronged responses, and holding programmes accountable for equity outcomes. |
| Presenters and Affiliations | Krista Kruja Evidence Link Sophie Witter Queen Margaret University Nouria Bricki London School of Hygiene and Tropical Medicine Maria Paola Bertone Institute for Global Health and Development, Queen Margaret University |
