wow-inequalities/02-data/intermediate/wos_sample/95f843bc52f80e452adfe93c8c4c3eeb-dyer-silke-j.-and-v/info.yaml

abstract: 'STUDY QUESTION: How do households recover financially from direct

  out-of-pocket payment for government subsidized ART?

  SUMMARY ANSWER: After a mean of 3.8 years, there was poor recovery from

  initiated financial coping strategies with the poorest households being

  disproportionatley affected.

  WHAT IS KNOWN ALREADY: Out-of-pocket payment for health services can

  create financial burdens for households and inequities in access to

  care. A previous study conducted at a public-academic institution in

  South Africa documented that patient co-payment for one cycle of ART

  resulted in catastrophic expenditure for one in five households, and

  more frequently among the poorest, requiring diverse financial coping

  strategies to offset costs.

  STUDY DESIGN, SIZE, DURATION: An observational follow-up study was

  conducted similar to 4 years later to assess financial recovery among

  the 135 couples who had participated in this previous study. Data were

  collected over 12 months from 73 informants.

  PARTICIPANTS/MATERIALS, SETTING, METHOD: The study was conducted at a

  level three referral hospital in the publicacademic health sector of

  South Africa. At this institution ART is subsidized but requires patient

  co-payments. A purpose-built questionnaire capturing socio-economic

  information and recovery from financial coping strategies which had been

  activated was administered to all informants. Financial recovery was

  defined as the resolution of strategies initiated for the specific

  purpose of covering the original ART cycle. Results were analysed by

  strategy and household with the latter including analysis by tertiles

  based on socio-economic status at the time of the original expenditure.

  In addition to descriptive statistics, the Pearson Chi squared test was

  used to determine differences between socioeconomic tertiles and

  associations between recovery and other variables.

  MAIN RESULTS AND THE ROLE OF CHANCE: The participation rate in this

  follow-up study was 54.1\% with equal representation from the three

  socio-economic tertiles. The average duration of follow-up was 46.1

  months (+/- 9.78 SD) and respondents'' mean age was 42 years (range

  31-52). The recovery rate was below 50\% for four of five strategies

  evaluated: 23.1\% of households had re-purchased a sold asset; 23.5\%

  had normalized a previous reduction in household spending, 33.8\% had

  regained their savings, and 48.7\% were no longer bolstering income

  through additional work. Two-thirds of households (60.0\%) had repaid

  all loans and debts. The poorest households showed lower rates of

  recovery when compared to households in the richest tertile. Complete

  recovery from all strategies initiated was reported by only 10

  households (13.7\%): 1 of 19 in the lowest tertile, 3 of 30 in the

  middle and by 6 of 24 households in the richest tertile (P > 0.05). No

  association was found between the degree of financial recovery and

  additional cost burdens incurred, including related to babies born; or

  between the degree of recovery and ongoing pursuit of ART.

  LIMITATIONS, REASONS FOR CAUTION: The sample size was limited. The

  participation rate was just over 50\%. Results were dependent on

  participants'' narrative and recall.

  WIDER IMPLICATIONS OF THE FINDINGS: The willingness of patients to pay

  for ART does not necessarily imply the ability to pay. As a result, the

  lack of comprehensive third-party funding for ART can create immediate

  and long-term financial hardship which is more pronounced among poorer

  households. While more data on the impact of out-of-pocket payment for

  ART are needed to illustrate the problem in other low resource settings,

  the results from South Africa provide useful information for similar

  developing countries. The current absence of more extensive data should

  therefore not be a barrier to the promotion of financial risk protection

  for infertile couples, especially the poorest, in need of ART.'
affiliation: 'Dyer, SJ (Corresponding Author), Groote Schuur Hosp, Dept Obstet \&
  Gynaecol, Main Rd, ZA-7925 Observatory, South Africa.

  Dyer, Silke J.; Vinoos, Latiefa, Univ Cape Town, Groote Schuur Hosp, Dept Obstet
  \& Gynaecol, Main Rd, ZA-7925 Cape Town, South Africa.

  Dyer, Silke J.; Vinoos, Latiefa, Univ Cape Town, Fac Hlth Sci, Main Rd, ZA-7925
  Cape Town, South Africa.

  Ataguba, John E., Univ Cape Town, Fac Hlth Sci, Hlth Econ Unit, Anzio Rd, ZA-7925
  Cape Town, South Africa.'
author: Dyer, Silke J. and Vinoos, Latiefa and Ataguba, John E.
author-email: silke.dyer@uct.ac.za
author_list:
- family: Dyer
  given: Silke J.
- family: Vinoos
  given: Latiefa
- family: Ataguba
  given: John E.
da: '2023-09-28'
doi: 10.1093/humrep/dex315
eissn: 1460-2350
files: []
issn: 0268-1161
journal: HUMAN REPRODUCTION
keywords: 'assisted reproductive technology; out-of-pocket payment; infertility;

  health economics; Africa; health expenditures; income; developing

  countries'
keywords-plus: 'DEVELOPING-COUNTRIES; COPING STRATEGIES; ECONOMIC-IMPACT; HEALTH-CARE;

  INFERTILITY; CONSEQUENCES; PATIENT; SECTOR; COSTS; INDIA'
language: English
month: DEC
number: '12'
number-of-cited-references: '24'
orcid-numbers: Ataguba, John Ele-Ojo/0000-0002-7746-3826
pages: 2431-2436
papis_id: e26809c535eaccc1443b0d3896d625b1
ref: Dyer2017poorrecovery
times-cited: '8'
title: Poor recovery of households from out-of-pocket payment for assisted reproductive
  technology
type: article
unique-id: WOS:000417055700009
usage-count-last-180-days: '0'
usage-count-since-2013: '7'
volume: '32'
web-of-science-categories: Obstetrics \& Gynecology; Reproductive Biology
year: '2017'