Abstract
Catastrophic healthcare expenditure (CHE) occurs in all countries and is responsible for inequalities in access to health care, particularly in low- and middle-income countries. The objective of this work is to analyse the determinants of CHEs in households living in Côte d'Ivoire. The data for the study are from the national household living standards survey conducted from January 23 to March 25, 2015 by the National Statistics Institute of Côte d’Ivoire (Institut National de la Statistique de Côte d'Ivoire). A one-way analysis and logistic regression were conducted to measure the association between CHEs and the socio-demographic, economic and health characteristics of households. The sample consisted of 12,899 households. Nearly 4% of households had experienced CHEs after completing OOPs. CHEs were more frequent in households including people over 65 years of age (OR: 4.75; 95% CI: 1.66-13.58), with chronic disease (OR: 2.10; 95% CI: 1.43-3.08), with more comfortable living conditions. Households without health insurance experienced fewer CHEs (OR: 0.29; 95% CI: 0.09-0.85) with large households including people over 65 years of age (OR: 0.60 95% CI: 0.40-0.91). This work highlighted socio-demographic and health determinants of CHEs. The reduction of CHEs involves considering social and individual factors.
Highlights
Households may experience financial hardship after using healthcare services called catastrophic healthcare expenditures (CHE) that may lead to impoverishment [1,2,3,4]
We considered households incurred CHE if their total out of pocket health cost exceeded 40% of their non-food expenditure [6, 20]
Our results show that nearly 1% of households had experienced CHE in the overall sample and 4% of those who had done out of pocket (OOP)
Summary
Households may experience financial hardship after using healthcare services called catastrophic healthcare expenditures (CHE) that may lead to impoverishment [1,2,3,4]. Health expenditure is described as catastrophic when direct payments (OOP) exceed a threshold where individuals must give up the consumption of other essential goods and services [3, 5, 6]. These CHE occur in all countries and regardless of the socio-economic status of individuals, and are increasing. Africa has the highest population growth rate exposed to this type of expenditure, with an average growth rate of more than 5.9% a year This breakdown of CHE is explained by the fact that households are the main source of health funding in these countries and OOPs represent the majority share [3]
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