The economics of healthcare access in developing countries: A scoping review on the economic impact of healthcare access for urban populations

Date & Time
Wednesday, September 6, 2023, 12:30 PM - 2:00 PM
Location Name
Session Type
Global health and equity
Siqueira N1, Li J1, A Phillips-Howard P2, Quayyum Z3, Kibuchi E4, Hossain I3, Vidyasagara A1, Sai V5, Manzoor F3, Karuga R6, Awal A3, Chumo I7, Rao V8, Mberu B7, Smith J9, Saidu S9, Tolhurst R2, Mazumdar S1, Rosu L2, Garimella S5, Elsey H1
1University of York, UK
2Liverpool School of Tropical Medicine, UK
3BRAC University, Bangladesh
4Glasgow University, UK
5The George Institute for Global Health, India
6LVCT Health, Kenya
7African Population and Health Research Center, Kenya
8The Society for Promotion of Area Resource Centres, India
9COMAHS: University of Sierra Leone, Sierra Leone

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.