Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt

Abstract Background The Syrian conflict has created the worst humanitarian refugee crisis of our time, with the largest number of people displaced. Many have sought refuge in Egypt, where they are provided with the same access to healthcare services as Egyptian citizens. Nevertheless, in addition to...

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Autores principales:	Hani Fares, Jaume Puig-Junoy
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Refugees’ health Socioeconomic inequalities Inequity Horizontal inequity Syrian refugees Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/a025754d836947e3b36378129dbae02a
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spelling	oai:doaj.org-article:a025754d836947e3b36378129dbae02a2021-11-07T12:17:29ZInequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt10.1186/s13031-021-00416-y1752-1505https://doaj.org/article/a025754d836947e3b36378129dbae02a2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13031-021-00416-yhttps://doaj.org/toc/1752-1505Abstract Background The Syrian conflict has created the worst humanitarian refugee crisis of our time, with the largest number of people displaced. Many have sought refuge in Egypt, where they are provided with the same access to healthcare services as Egyptian citizens. Nevertheless, in addition to the existing shortcomings of the Egyptian health system, many obstacles specifically limit refugees’ access to healthcare. This study looks to assess equity across levels of care after observing services utilization among the Syrian refugees, and look at the humanitarian dilemma when facing resource allocation and the protection of the most vulnerable. Methods A cross‐sectional survey was used and collected information related to access and utilization of outpatient and inpatient health services by Syrian refugees living in Egypt. We used concentration index (CI), horizontal inequity (HI) and benefit incidence analysis (BIA) to measure the inequity in the use of healthcare services and distribution of funding. We decomposed inequalities in utilization, using a linear approximation of a probit model to measure the contribution of need, non-need and consumption influential factors. Results We found pro-rich inequality and horizontal inequity in the probability of refugees’ outpatient and inpatient health services utilization. Overall, poorer population groups have greater healthcare needs, while richer groups use the services more extensively. Decomposition analysis showed that the main contributor to inequality is socioeconomic status, with other elements such as large families, the presence of chronic disease and duration of asylum in Egypt further contributing to inequality. Benefit incidence analysis showed that the net benefit distribution of subsidies of UNHCR for outpatient and inpatient care is also pro-rich, after accounting for out-of-pocket expenditures. Conclusion Our results show that without equitable subsidies, poor refugees cannot afford healthcare services. To tackle health inequities, UNHCR and organisations will need to adapt programmes to address the social determinants of health, through interventions within many sectors. Our findings contribute to assessments of different levels of accessibility to healthcare services and uncover related sources of inequities that require further attention and advocacy by policymakers.Hani FaresJaume Puig-JunoyBMCarticleRefugees’ healthSocioeconomic inequalitiesInequityHorizontal inequitySyrian refugeesSpecial situations and conditionsRC952-1245Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENConflict and Health, Vol 15, Iss 1, Pp 1-14 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Refugees’ health Socioeconomic inequalities Inequity Horizontal inequity Syrian refugees Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Refugees’ health Socioeconomic inequalities Inequity Horizontal inequity Syrian refugees Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Hani Fares Jaume Puig-Junoy Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt
description	Abstract Background The Syrian conflict has created the worst humanitarian refugee crisis of our time, with the largest number of people displaced. Many have sought refuge in Egypt, where they are provided with the same access to healthcare services as Egyptian citizens. Nevertheless, in addition to the existing shortcomings of the Egyptian health system, many obstacles specifically limit refugees’ access to healthcare. This study looks to assess equity across levels of care after observing services utilization among the Syrian refugees, and look at the humanitarian dilemma when facing resource allocation and the protection of the most vulnerable. Methods A cross‐sectional survey was used and collected information related to access and utilization of outpatient and inpatient health services by Syrian refugees living in Egypt. We used concentration index (CI), horizontal inequity (HI) and benefit incidence analysis (BIA) to measure the inequity in the use of healthcare services and distribution of funding. We decomposed inequalities in utilization, using a linear approximation of a probit model to measure the contribution of need, non-need and consumption influential factors. Results We found pro-rich inequality and horizontal inequity in the probability of refugees’ outpatient and inpatient health services utilization. Overall, poorer population groups have greater healthcare needs, while richer groups use the services more extensively. Decomposition analysis showed that the main contributor to inequality is socioeconomic status, with other elements such as large families, the presence of chronic disease and duration of asylum in Egypt further contributing to inequality. Benefit incidence analysis showed that the net benefit distribution of subsidies of UNHCR for outpatient and inpatient care is also pro-rich, after accounting for out-of-pocket expenditures. Conclusion Our results show that without equitable subsidies, poor refugees cannot afford healthcare services. To tackle health inequities, UNHCR and organisations will need to adapt programmes to address the social determinants of health, through interventions within many sectors. Our findings contribute to assessments of different levels of accessibility to healthcare services and uncover related sources of inequities that require further attention and advocacy by policymakers.
format	article
author	Hani Fares Jaume Puig-Junoy
author_facet	Hani Fares Jaume Puig-Junoy
author_sort	Hani Fares
title	Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt
title_short	Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt
title_full	Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt
title_fullStr	Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt
title_full_unstemmed	Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt
title_sort	inequity and benefit incidence analysis in healthcare use among syrian refugees in egypt
publisher	BMC
publishDate	2021
url	https://doaj.org/article/a025754d836947e3b36378129dbae02a
work_keys_str_mv	AT hanifares inequityandbenefitincidenceanalysisinhealthcareuseamongsyrianrefugeesinegypt AT jaumepuigjunoy inequityandbenefitincidenceanalysisinhealthcareuseamongsyrianrefugeesinegypt
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Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt

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