Universal health coverage initiatives in Guinea have been hampered by insufficient budget allocations and inefficiencies. Nevertheless, data on the extent of catastrophic and impoverishing health expenditures in Guinea are scarce and outdated. The objectives of this study were to (1) identify the drivers of total health expenditures, (2) estimate the prevalence of catastrophic and impoverishing health expenditures, and (3) estimate the drivers of and potential financial risk protection against catastrophic and impoverishing health expenditures through subsidies in Guinea. A retrospective cohort study was conducted using the 2018-19 Guinea Living Standards Measurement Study. All 41,449 individuals in the Study were eligible, but 15 individuals who lacked consumption expenditure data were excluded. Expenditure data were converted to 2019 international dollars. Based on means and medians, the primary drivers of total health expenditures were hospitalizations (8 and 1, respectively) and medications (2 and 1, respectively). Based on the distribution of total health expenditures by expenditure categories, the primary driver was medications (75 percent). The main driver of hospitalization expenditures was fever and malaria (21 percent of hospitalization expenditures). The prevalences of catastrophic and health expenditures (equal to or greater than 10 percent threshold) and impoverishing health expenditures were 13 and 4 percent, respectively. Subsidizing medications would prevent 46 percent of the cases of catastrophic health expenditures and 73 percent of the cases of impoverishing health expenditures. It is recommended that the Guinean government (1) strengthen the country's pharmaceutical sector by reinforcing existing laws and regulations and the operational aspects of the sector
(2) implement subsidy programs for rational use of medicines (notwithstanding the Bamako Initiative)
(3) strengthen the National Malaria Control Program
and (4) establish an evidence-based operational financing strategy for universal health coverage.