Abstract
BackgroundOut-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries. Yet, there has been no systematic examination of which specific diseases and conditions (e.g., tuberculosis, cardiovascular disease) drive medical impoverishment, defined as OOP direct medical costs pushing households into poverty.MethodsWe used a cost and epidemiological model to propose an assessment of the burden of medical impoverishment in Ethiopia, i.e., the number of households crossing a poverty line due to excessive OOP direct medical expenses. We utilized disease-specific mortality estimates from the Global Burden of Disease study, epidemiological and cost inputs from surveys, and secondary data from the literature to produce a count of poverty cases due to OOP direct medical costs per specific condition.ResultsIn Ethiopia, in 2013, and among 20 leading causes of mortality, we estimated the burden of impoverishment due to OOP direct medical costs to be of about 350,000 poverty cases. The top three causes of medical impoverishment were diarrhea, lower respiratory infections, and road injury, accounting for 75 % of all poverty cases.ConclusionsWe present a preliminary attempt for the estimation of the burden of medical impoverishment by cause for high mortality conditions. In Ethiopia, medical impoverishment was notably associated with illness occurrence and health services utilization. Although currently used estimates are sensitive to health services utilization, a systematic breakdown of impoverishment due to OOP direct medical costs by cause can provide important information for the promotion of financial risk protection and equity, and subsequent design of health policies toward universal health coverage, reduction of direct OOP payments, and poverty alleviation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0697-0) contains supplementary material, which is available to authorized users.
Highlights
Out-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries
For simplicity, we selected 20 conditions established as major causes of mortality in Ethiopia, and deemed to likely incur substantial OOP direct medical costs
The 20 causes of mortality were ranked according to the level of medical impoverishment due to OOP direct costs they incurred, allowing us to infer what inputs might have the largest impact based on cause of death, OOP costs, and utilization (Table 2; Fig. 1)
Summary
Out-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries. High out-of-pocket (OOP) medical expenses can lead to impoverishment in many low- and middle-income countries [1, 2]. Well-designed health policies are critical for the minimization of financial risks tied to OOP direct medical expenses. The prevention of medical impoverishment, defined here as OOP direct medical costs pushing households below the poverty line or leading to catastrophic medical expenditure, is a major objective of health systems and policy instruments such as insurance and public finance [7]. Analyzing the composition of OOP direct medical payments per cause can help design health systems better at preventing such catastrophic expenditure, which have been estimated to be substantial [8]
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