9 research outputs found
Determinants of demand for health insurance in Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of a Master of Arts Degree in Economics of Makerere University.Although health insurance is not new in Uganda, the proportion of the population that utilises it, is at a meager 5 percent, with willingness to pay for health insurance standing at only 11 percent. In the absence of a national health insurance scheme, health sector financing is largely not pre-paid. Therefore, it is against this background that the study examined the determinants of demand for health insurance in Uganda. The study applied a logit model to secondary data from the UNHS 2016/17 conducted by UBOS and the results reveal that awareness about health insurance, age of an individual, one’s marital status, the education level, area of residence, wealth and the size of a household are significantly associated with demand (utilisation) for health insurance, whereas awareness, marital status, health status, education level, area of residence, size of a household, wealth, the region of residence, as well as suffering from a non-communicable disease are significantly associated with an individual’s willingness to pay for health insurance. Results further reveal that an individual’s gender (male or female), age as well as price (expenditure on medical and health care) are not significantly associated with willingness to pay for health insurance. Most Ugandans are not aware of health insurance as a mode of paying for medical care yet awareness proved as a very crucial factor in determining the demand for health insurance. Generally, the willingness to pay does not translate into actual utilisation of health insurance in Uganda. The study, therefore, recommends for promoting of awareness about health insurance, increasing the literacy levels of Ugandans through education, promoting poverty reduction and income enhancing programmes as well as urgently implementing a National Health Insurance Scheme (NHIS)
Health Expenditure Shocks and Household Poverty Amidst COVID-19 in Uganda: How Catastrophic?
No full textIn this paper, we utilize the 2019/20 Uganda National Household Survey data to answer three related questions: (i) To what extent did out-of-pocket payments (OOPs) for health care services exceed the threshold for household financial catastrophe amidst COVID-19? (ii) What is the impoverishing effect of OOPs for health care services on household welfare? (iii) What are the socioeconomic and demographic determinants of OOPs for health care services in Uganda? Leveraging three health expenditure thresholds (10%, 25%, and 40%), we run a Tobit model for “left-censored” health expenditures and quantile regressions, and we find that among households which incur any form of health care expense, 37.7%, 33.6%, and 28.7% spend more than 10%, 25%, and 40% of their non-food expenditures on health care, respectively. Their average OOP budget share exceeds the respective thresholds by 82.9, 78.0, and 75.8 percentage points. While, on average, household expenditures on medicine increased amidst the COVID-19 pandemic, expenditures on consultations, transport, traditional doctors’ medicines, and other unbroken hospital charges were reduced during the same period. We find that the comparatively low incidence and intensity of catastrophic health expenditures (CHEs) in the pandemic period was not necessarily due to low household health spending, but due to foregone and substituted care. Precisely, considering the entire weighted sample, about 22% of Ugandans did not seek medical care during the pandemic due to a lack of funds, compared to 18.6% in the pre-pandemic period. More Ugandans substituted medical care from health facilities with herbs and home remedies. We further find that a 10% increase in OOPs reduces household food consumption expenditures by 2.6%. This modality of health care financing, where households incur CHEs, keeps people in chronic poverty
Limited health insurance coverage amidst upsurge of non-communicable diseases in Uganda
Full text linkThis brief uses the 2016/17 Uganda National Household Survey (UNHS) and the World Development Indicators (WDI) to show the extent of health insurance coverage for non-communicable diseases (NCDs) such as diabetes, high blood pressure and heart diseases among others. Results indicate that: (i) NDCs affect people of all socio-economic groups; (ii) more Ugandans suffering from NCDs are willing to pay for health insurance, but very few are holders of insurance policies in this regard; (iii) other diseases like malaria are more easily insured compared to NCDs, an indication that the providers of health insurance services are not keen to insure sufferers of NCDs; (iv) there are regional differences in health insurance coverage as well as prevalence of NCDs, with the burden of NCDs more intense in the Bukedi, Busoga and Teso sub-regions, whereas NCDs are least prevalent in Kigezi and Ankole sub-regionsand (v) NCDs are likely to erode gains in poverty reduction at household level, because it is equally high among poor households with the least capacity to afford health insurance. We there by, recommend establishing special screening centres for NCDs in public health facilities especially health center II’s and III’s. This will promote early detection and early treatment hence curbing expensive costs for treating severe and chronic NCDs. Preventive measures need to be emphasized as well. These include regular body exercises and monitored nutrition which all lower the risk of NCDs. We further suggest incorporating and prioritizing NCDs into the proposed national health insurance scheme
Health Expenditure Shocks Worsened Household Poverty Amidst COVID-19 in Uganda
Full text linkAmidst the COVID-19 pandemic a lot changed regarding health care financing, both globally and nationally – in Uganda. Households faced unprecedented economic constraints and were forced to make hard expenditure choices including whether and how to spend on health care. Relatedly, the number of poor Ugandans increased from eight million in 2016/17 to 8.3 million in 2019/20, but it was still not clear how much of this impoverishment can be attributed to health xpenditure shocks amidst the pandemic. In addition, Uganda has consistently fallen short on living up to the 2001 Abuja Declaration expectations of allocating at least 15% of her national budget each year to improving the healthcare system. The size of the health sector budget has been less than half of the declaration requirement for the past five years (see Figure 1). More precisely, the health sector budget as a share of the total budget and GDP has averaged 6.4% and 1.9% respectively in the financial years 2018/19 to 2022/23. The absence of a national health insurance scheme implies that a huge health care financing burden, is borne by the households who pay for health care directly by out-of-pocket payments (OOPs)
Limited health insurance coverage amidst upsurge of non-communicable diseases in Uganda
No full textThis brief uses the 2016/17 Uganda National Household Survey (UNHS) and the World Development Indicators (WDI) to show the extent of health insurance coverage for non-communicable diseases (NCDs) such as diabetes, high blood pressure and heart diseases among others. Results indicate that: (i) NDCs affect people of all socio-economic groups; (ii) more Ugandans suffering from NCDs are willing to pay for health insurance, but very few are holders of insurance policies in this regard; (iii) other diseases like malaria are more easily insured compared to NCDs, an indication that the providers of health insurance services are not keen to insure sufferers of NCDs; (iv) there are regional differences in health insurance coverage as well as prevalence of NCDs, with the burden of NCDs more intense in the Bukedi, Busoga and Teso sub-regions, whereas NCDs are least prevalent in Kigezi and Ankole sub-regionsand (v) NCDs are likely to erode gains in poverty reduction at household level, because it is equally high among poor households with the least capacity to afford health insurance. We there by, recommend establishing special screening centres for NCDs in public health facilities especially health center II’s and III’s. This will promote early detection and early treatment hence curbing expensive costs for treating severe and chronic NCDs. Preventive measures need to be emphasized as well. These include regular body exercises and monitored nutrition which all lower the risk of NCDs. We further suggest incorporating and prioritizing NCDs into the proposed national health insurance scheme
Linking crop productivity, market participation and technology use among smallholder farmers: Evidence from Uganda
No full textIn this paper, we establish the link between crop productivity, crop market participation and agricultural technology use among smallholder farmers. We take advantage of the latest four waves of the Uganda National Panel Survey – 2013/14, 2015/16, 2018/19, and 2019/20. First, we test for complementarity of agricultural technology use among smallholder farmers, and we do not find evidence for the combined effect of organic and inorganic fertilizers as well as pesticides and organic fertilizers on crop yields, which implies that there is lack of complementarity. More precisely, smallholder farmers mostly use these agricultural technologies in isolation. However, we find strong individual effect of organic fertilizers on cassava, beans, and coffee yields. Second, we use a two-step factor analysis to construct four technology sub-indexes for improved seeds, pesticides, organic, and inorganic fertilizers in the first step and the overall agricultural technology index in the second step. We run crop-specific models and the results re-affirm a positive effect of agricultural technology use on both cassava and coffee yields. Third, when we attempt to measure crop productivity as farm productivity, we find that a unit increase in inorganic fertilizers used increases farm crop productivity by 69%. We do not see this strong effect of inorganic fertilizers on our partial measure of crop productivity – crop yields – which implies that the way we measure crop productivity matters. We therefore conclude that of the four agricultural technologies, inorganic fertilizers have the strongest individual effect on farm productivity of smallholder farmers. Fourth, we employ the Heckman twostep technique to correct the selection bias in crop market participation outcomes. We do not find strong evidence of the effect of agricultural technology use on crop market participation, but we find that it is rather crop yields that are most critical for market participation. Therefore, a farmer’s cropproductivity is arguably the most critical facilitator or inhibitor of their market participation. More precisely, to boost crop market participation among smallholder farmers, increasing their productivity is a necessary condition
Uncovered Silent Killers: The Prevalence of Non-Communicable Diseases and Health Insurance Coverage in Uganda
Full text linkIn this paper, we investigate the extent of utilization and willingness to pay for health insurance in Uganda. Specifically, we examine the effect of Non-Communicable Diseases (NCDs) on both utilization and willingness to pay for health insurance. We apply a binary logistic model on the 2016/17 Uganda National Household Survey (UNHS) data, and the results indicate that, individuals living with NCDs like diabetes, high blood pressure, and heart diseases, are less likely to utilize health insurance compared to those without such diseases. We also find that, although Ugandans suffering from NCDs are willing to pay for health insurance, very few are holders of health insurance policies. More precisely, their willingness to pay does not translate into actual uptake. The results further reveal that awareness about health insurance and wealth, are very crucial factors in an individual’s willingness to pay, as well as utilization of health insurance. Therefore, policies geared towards enhancing health insurance uptake will go a long way in ensuring protection against NCDs. Such policies have to mitigate both demand and supply hindrances to health insurance uptake. For instance, massive awareness programmes, poverty reduction and income enhancing programmes, as well as implementation of a national health insurance scheme
Linking crop productivity, market participation and technology use among smallholder farmers: Evidence from Uganda
No full textIn this paper, we establish the link between crop productivity, crop market participation and agricultural technology use among smallholder farmers. We take advantage of the latest four waves of the Uganda National Panel Survey – 2013/14, 2015/16, 2018/19, and 2019/20. First, we test for complementarity of agricultural technology use among smallholder farmers, and we do not find evidence for the combined effect of organic and inorganic fertilizers as well as pesticides and organic fertilizers on crop yields, which implies that there is lack of complementarity. More precisely, smallholder farmers mostly use these agricultural technologies in isolation. However, we find strong individual effect of organic fertilizers on cassava, beans, and coffee yields. Second, we use a two-step factor analysis to construct four technology sub-indexes for improved seeds, pesticides, organic, and inorganic fertilizers in the first step and the overall agricultural technology index in the second step. We run crop-specific models and the results re-affirm a positive effect of agricultural technology use on both cassava and coffee yields. Third, when we attempt to measure crop productivity as farm productivity, we find that a unit increase in inorganic fertilizers used increases farm crop productivity by 69%. We do not see this strong effect of inorganic fertilizers on our partial measure of crop productivity – crop yields – which implies that the way we measure crop productivity matters. We therefore conclude that of the four agricultural technologies, inorganic fertilizers have the strongest individual effect on farm productivity of smallholder farmers. Fourth, we employ the Heckman twostep technique to correct the selection bias in crop market participation outcomes. We do not find strong evidence of the effect of agricultural technology use on crop market participation, but we find that it is rather crop yields that are most critical for market participation. Therefore, a farmer’s cropproductivity is arguably the most critical facilitator or inhibitor of their market participation. More precisely, to boost crop market participation among smallholder farmers, increasing their productivity is a necessary condition.Non-PRIFPRI5; DCA; Capacity Strengthening; 4 Transforming Agricultural and Rural EconomiesInnovation Policy and Scaling (IPS); Transformation Strategie
Sovereignty Clause in the Common European Asylum System : Right or Obligation?
Full text linkRad analizira klauzulu suverenosti ili diskrecionu klauzulu po kojoj država
članica Evropske unije može preuzeti odgovornost za ispitivanje zahteva
za azil čak i ukoliko je druga država članica odgovorna za ispitivanje azilnog
zahteva primenom kriterijuma sadržanih u Uredbi Dablin. U radu se najpre
prikazuju i porede rešenja prihvaćena u različitim verzijama pomenute Uredbe,
čime se ukazuje na specifičnu evoluciju kroz koju je klauzula suverenosti prošla
na normativnom nivou. Za razliku od Suda pravde EU koji je početkom 2019.
godine stao na stanovište da klauzula suverenosti predstavlja mogućnost ali ne
i obavezu za državu članicu da preuzme odgovornost za ispitivanje zahteva za
azil, Evropski sud za ljudska prava smatra da je država članica Unije odgovorna
za povredu prava iz Konvencije ukoliko je primenom klauzule suverenosti ta
povreda mogla biti izbegnuta. Iako inicijalno usklađeni, stavovi dva evropska
suda u vezi s primenom klauzule suverenosti u poslednjih par godina su se značajno
udaljili i to ne samo po pitanju da li klauzula sadrži pravo ili obavezu za
članice, već i u pogledu značenja i domašaja te odredbe. Te razlike će neminovno
uticati i na praksu država članica koje klauzulu suverenosti primenjuju pod
jakim uticajem prakse dva evropska suda.The paper analyzes the sovereignty clause or discretionary clause according
to which EU Member States may take responsibility for examining an asylum
application even if, by applying the criteria contained in the Dublin Regulation,
another Member State is determined as responsible. The author firstly outlines
and compares the solutions contained in different versions of the aforementioned
Regulation, thus indicating the specific manner in which the sovereignty
clause has evolved at the normative level throughout the years. Unlike the Court
of Justice of the EU, which in early 2019 held that the sovereignty clause constituted
an opportunity, not an obligation, for a Member State to take responsibility
for examining an asylum claim, the European Court of Human Rights held
that the EU Member State was responsible for the violation of rights guaranteed
by the European Convention if such a violation could have been avoided by
applying the sovereignty clause. Although initially aligned, the views of the two
European Courts regarding the application of the sovereignty clause have significantly
departed during the last couple of years, not only as to whether the
clause contains a right or obligation for Member States, but also in terms of its
meaning and scope. These differences will inevitably affect the practice of Member
States since their application of the sovereignty clause is under the strong
influence of the practice of the two European Courts
