Abstract
ObjectiveTo determine the incidence of – and illnesses commonly associated with – catastrophic household expenditure on health in Nepal.MethodsWe did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household’s total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. FindingsOverall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease.ConclusionIn an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.
Highlights
In many developing countries, a large proportion of the money spent on health care comes from the out-of-pocket expenditure of patients or their families
Financial protection against the risk of catastrophic health expenditure at household level can be achieved through tax-based health financing systems or social health insurance schemes – or a combination of both.[6]
Mean no. of household members Proportion of household members (n = 9177) Aged < 5 years Aged > 65 years Mean age of household head, years (n = 1997) No (%) of household heads (n = 1997) Male Female With no education Educated only to primary level Educated only to secondary level With higher education Owning home Renting In home provided free of charge Squatting/occupying land illegally Living in other types of dwelling
Summary
A large proportion of the money spent on health care comes from the out-of-pocket expenditure of patients or their families. In Bangladesh, India and Nepal, for example, this proportion has been estimated to be 48–69%.1 Households in such countries can experience financial hardship and often impoverishment as a result of their spending on health care.[2,3,4,5] In the long term, financial protection against the risk of catastrophic health expenditure at household level can be achieved through tax-based health financing systems or social health insurance schemes – or a combination of both.[6] In developing countries that have inadequate public funds for health, some transitional measures such as voluntary community-based health insurance schemes may be introduced.[7] Low-income countries are increasingly either implementing essential health packages for disease treatment free of charge or providing patients – or their families – with conditional cash transfers for selected health services. Such interventions may often use up a large share of a country’s public health subsidies.[8]
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