It has been argued that OOPHE by households are involuntary and depending on the magnitude, such expenditures could result in cuts in consumption of basic necessities which undermines household's welfare and could lead to asset sales, running down of savings, indebtedness and impoverishment [ 5, 31, 32, 35, 49– 51].
Resampling techniques are employed to tackle degeneracy issues but sometimes when applied improperly can lead to sample impoverishment [21].
Health 'shocks' such as unexpected health expenditures, reduced functional capacity and lost income and productivity are primary risk factors for health impoverishment [2, 3].
High OOPE is positively associated with CHS and reduced access to health services, increases untreated morbidity, reduce consumption of goods and services, and lead to long-term impoverishment [2].
12 44 In Serbia, Roma are subject to immense social discrimination and impoverishment, 33 and we found that Roma transvestite sex workers reported being subjected to extreme acts of police violence.
Some authors posit that polygamy limits women's access to financial resources from their spouses and also forces them to share their limited resources in the household and thus exacerbate their impoverishment (43).
Stigma and discrimination due to mental illness are known to perpetuate a cycle of impoverishment [ 24, 25].
Others suggest the NCMS suffers from poor design and inefficiencies, and fails to protect against impoverishment [ 25, 30].
Financial risk protection for all has been achieved by UCS, resulting in a minimal prevalence of catastrophic health expenditure and financial hardship due to health payment so-called health impayment so-called 4].
However, many TB patients and families are still facing very high direct and indirect costs due to TB illness and care-seeking, hampering access and putting people at risk of financial ruin or further impoverishment [ 5, 6].
We saw that this study's oversampling from extremely poor neighborhoods seemed to fairly well control AA-NHWA differences on depth of impoverishment [ 22, 23], at least in terms of their annual household incomes that only differed by about $1,000.
