Assessing the relationship between out-of-pocket spending on blood pressure and diabetes medication and household catastrophic health expenditure: evidence from Pakistan

Biplab Kumar Datta,Samira Asma,Muhammad Jami Husain

doi:10.1186/s12939-018-0906-x

Abstract

BackgroundTreatment of non-communicable diseases (NCDs) in low-and-middle-income countries (LMICs) is costly and could expose households to financial hardship and vulnerability. This paper examines the association between medication costs of two major NCDs – hypertension (blood pressure) and diabetes, and household-level incidences of catastrophic health expenditure (CHE) in a South Asian LMIC, Pakistan.MethodsThe study analyzes self-reported blood pressure and diabetes (BPD) medication expenditure from the latest version (2015–16) of the Household Integrated Economic Survey (HIES) of Pakistan, a nationally representative survey of 24,238 households. The incidence of CHE is defined as households’ out-of-pocket (OOP) medical expenditure exceeding 10% of the total household expenditure. Using a linear probability model, we estimate the adjusted differences in CHE incidence between households that are spending and ‘not’ spending on BPD medication. We also analyze several hypothetical scenarios of BPD medication cost coverage, and compare the estimated CHE incidences of respective scenarios with the status quo.ResultsWe find that the average monthly medical expenditure, and average medical expenditure share are significantly higher for households spending on BPD medication, compared to households ‘not’ spending. The incidence of CHE is found 6.7 percentage point higher for the households consuming BPD medication, after controlling for relevant socioeconomic attributes. If 25, 50, and 100% of the BPD medication OOP cost is covered, then the CHE incidence would reduce respectively by 5.9, 12.7, and 21.4% compared to the status quo.ConclusionMedication cost for managing two major NCDs and household catastrophic health expenditure have strong associations. The findings inform policies toward ensuring access to necessary healthcare services, and protecting households from NCD treatment related financial hardship.

Highlights

Many low-and-middle-income countries (LMICs) are experiencing gradual epidemiologic transition as the greater burden of diseases has been shifting from infectious to non-communicable diseases [1,2,3]
The analysis presented in this paper is very pertinent to the goal of universal health coverage (UHC) for Pakistan, which requires that all people have access to needed health services of sufficient quality while ensuring that the use of these services does not expose families to financial hardship [22, 23]
We find that households in Pakistan that spend on blood pressure and/or diabetes medication, are more likely to incur catastrophic health expenditure than households that don’t spend on blood pressure and/or diabetes medication

Summary

Introduction

Many low-and-middle-income countries (LMICs) are experiencing gradual epidemiologic transition as the greater burden of diseases has been shifting from infectious to non-communicable diseases [1,2,3]. Pakistan is one of the LMICs experiencing transition in disease burden, as the number of deaths attributable to communicable diseases, and maternal, prenatal and nutrition conditions decreased from 50% in 2000 to 35% in 2015; and deaths attributable to NCDs increased from 43 to 56% during the same period [12] Infectious diseases such as hepatitis B and C, tuberculosis, malaria, and HIV are still major health threats in Pakistan [10]. This paper examines the association between medication costs of two major NCDs – hypertension (blood pressure) and diabetes, and household-level incidences of catastrophic health expenditure (CHE) in a South Asian LMIC, Pakistan

Methods

Results

Discussion

Conclusion