Catastrophic Out-of-Pocket Health Expenditure Among Rural Households in the Semi-Pastoral Community, Western Ethiopia: A Community-Based Cross-Sectional Study

Background Every year, 808 million people face catastrophic health expenditure (CHE), and 122 million people were pushed into poverty. It aggravates healthcare inequalities, incurs double burden opportunity costs, and pushes households to sit in a deep poverty trap. A few studies have been done so far; however, it is not enough to inform policy decisions. Therefore, this study aimed to assess the catastrophic out-of-pocket health expenditure and associated factors among rural households in Mandura District, Western Ethiopia. Methods We conducted a community-based cross-sectional study among the Mandura district’s 488 rural households from April to May 2017. We used a multistage systematic sampling technique to select the participants. We fitted a binary logistic regression model to identify the factors associated with catastrophic out-of-pocket health expenditure. We used the adjusted odds ratio (AOR) with 95% CI and the p-value <0.05 to determine the variables associated with catastrophic out-of-pocket health expenditure. Results Catastrophic health expenditure (CHE) with a 40% capacity to pay (CTP) households in the study area was 22.5%. Female household head (AOR = 2.92; 95% CI: 1.44, 5.93) and household with chronic illnesses (AOR = 3.93; 95% CI: 1.78, 9.14) were positively associated with CHE and, while households who had adult household members (AOR = 0.32; 95% CI: 0.16, 0.63) were negatively associated. Conclusion The overall CHE, with a 40% CTP threshold, was high. Prevention of chronic illness might help to reduce the burden of the expenditure. Strengthening financial risk protection mechanisms, such as community-based health insurance, could help bring healthcare services equity.

[1]  G. Moradi,et al.  Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality , 2020, Diabetes, metabolic syndrome and obesity : targets and therapy.

[2]  A. Alshreef.  Provider Payment Mechanisms: Effective Policy Tools for Achieving Universal and Sustainable Healthcare Coverage , 2019, Universal Health Coverage [Working Title].

[3]  G. Moradi,et al.  Catastrophic health expenditure and its determinants in households with gastrointestinal cancer patients: evidence from new health system reform in Iran , 2019, International Journal of Human Rights in Healthcare.

[4]  E. Rad,et al.  Socioeconomic inequality in catastrophic healthcare expenditures in Western Iran , 2019, International Journal of Social Economics.

[5]  S. Rezaei,et al.  Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran , 2019, Journal of preventive medicine and public health = Yebang Uihakhoe chi.

[6]  Ali Kazemi Karyani,et al.  Catastrophic healthcare expenditures among Iranian households: a systematic review and meta-analysis , 2019, International Journal of Human Rights in Healthcare.

[7]  J. Cylus,et al.  Catastrophic health spending in Europe: equity and policy implications of different calculation methods , 2018, Bulletin of the World Health Organization.

[8]  A. Wagstaff,et al.  Progress on impoverishing health spending in 122 countries: a retrospective observational study. , 2017, The Lancet. Global health.

[9]  A. Wagstaff,et al.  Progress on catastrophic health spending in 133 countries: a retrospective observational study. , 2017, The Lancet. Global health.

[10]  J. L. Amaya-Lara.  Catastrophic expenditure due to out-of-pocket health payments and its determinants in Colombian households , 2016, International Journal for Equity in Health.

[11]  M. Svensson,et al.  Catastrophic health expenditure and impoverishment in Mongolia , 2016, International Journal for Equity in Health.

[12]  U. Kioko,et al.  Catastrophic Health Expenditures And Impoverishment In Kenya , 2016 .

[13]  Y. Do,et al.  Catastrophic Health Expenditures for Households with Disabled Members: Evidence from the Korean Health Panel , 2016, Journal of Korean medical science.

[14]  A. Rashad,et al.  Catastrophic Economic Consequences of Healthcare Payments: Effects on Poverty Estimates in Egypt, Jordan, and Palestine , 2015 .

[15]  Philipps-Universitat Marburg,et al.  Catastrophic and Impoverishing Effects of Out-of-Pocket Health Expenditure: New Evidence from Egypt , 2015 .

[16]  Ashutosh Kumar Singh,et al.  Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE , 2015, PloS one.

[17]  Djesika D. Amendah,et al.  Catastrophic health expenditure and its determinants in Kenya slum communities , 2015, International Journal for Equity in Health.

[18]  E. Park,et al.  Association between chronic disease and catastrophic health expenditure in Korea , 2015, BMC Health Services Research.

[19]  R. Ravangard,et al.  Household Financial Contribution to the Health System in Shiraz, Iran in 2012 , 2014, International journal of health policy and management.

[20]  K. Shibuya,et al.  Catastrophic household expenditure on health in Nepal: a cross-sectional survey , 2014, Bulletin of the World Health Organization.

[21]  Chaojie Liu,et al.  Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play? , 2014, PloS one.

[22]  Ajay Mahal,et al.  Economic impacts of health shocks on households in low and middle income countries: a review of the literature , 2014, Globalization and Health.

[23]  U. Enemark,et al.  Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey , 2014, BMC International Health and Human Rights.

[24]  H. Binnendijk.  Designing Community-Based Health Insurance among Rural Poor in India: A novel time- and cost-effective method for data sourcing , 2014 .

[25]  Jay J. Shen,et al.  Household catastrophic medical expenses in eastern China: determinants and policy implications , 2013, BMC Health Services Research.

[26]  Shuangge Ma,et al.  Impact of Illness and Medical Expenditure on Household Consumptions: A Survey in Western China , 2012, PloS one.

[27]  Ling Xu,et al.  Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. , 2012, Bulletin of the World Health Organization.

[28]  M. Karami,et al.  Household Catastrophic Health Expenditure , 2011, Iranian journal of public health.

[29]  D. Peters,et al.  Catastrophic out-of-pocket payment for health care and its impact on households : Experience from West Bengal , India , 2010 .

[30]  G. Carrin,et al.  Designing health financing systems to reduce catastrophic health expenditure , 2005 .

[31]  Adam Wagstaff,et al.  Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. , 2003, Health economics.

[32]  C. Murray,et al.  Household catastrophic health expenditure: a multicountry analysis , 2003, The Lancet.

[33]  S. Musau,et al.  Guide to designing and managing community-based health financing schemes in East and Southern Africa. Including Toolkit Version 1. , 2000 .