Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey

Mamata Ghimire,Rakesh Ayer,Masahide Kondo

doi:10.1186/s12939-018-0736-x

Abstract

BackgroundNepal has committed to the global community to achieve universal health coverage by 2030. Nevertheless, Nepal still has a high proportion of out-of-pocket health payment and a limited risk-pooling mechanism. Out-of-pocket payment for the healthcare services could result in catastrophic health expenditure (CHE). Evidence is required to effectively channel the efforts to lower those expenses in order to achieve universal health coverage. However, little is known about CHE and its determinants in a broad national context in Nepal. Therefore, this study was conducted to explore the cumulative incidence, distribution, and determinants of CHE in Nepal.MethodsData were obtained from the nationally representative survey, the Nepal Living Standards Survey-third undertaken in 2010/11. Information from 5988 households was used for the analyses. Households were classified as having CHE when their out-of-pocket health payment was greater than or equal to 40% of their capacity to pay. Remaining households were classified as not having CHE. Logistic regression analyses were used to identify determinants of CHE.ResultsBased on household-weighted sample, the cumulative incidence of CHE was 10.3% per month in Nepal. This incidence was concentrated in the far-western region and households in the poorer expenditure quartiles. Multivariable logistic regression revealed that households were more likely to face CHE if they; consisted of chronically ill member(s), have a higher burden of acute illness and injuries, have elderly (≥60 years) member(s), belonged to the poor expenditure quartile, and were located in the far-western region. In contrast, households were less likely to incur CHE when their household head was educated. Having children (≤5 years) in households did not significantly affect catastrophic health expenditure.ConclusionsThis study identified a high cumulative incidence of CHE. CHE was disproportionately concentrated in the poor households and households located in the far-western region. Policy-makers should focus on prioritizing households vulnerable to CHE. Interventions to reduce economic burden of out-of-pocket healthcare payment are imperative to lower incidences of CHE among those households. Improving literacy rate might also be useful in order to lower CHE and facilitate universal health coverage.

Highlights

Nepal has committed to the global community to achieve universal health coverage by 2030
catastrophic health expenditure (CHE) was disproportionately concentrated in the poor households and households located in the far-western region
Improving literacy rate might be useful in order to lower CHE and facilitate universal health coverage

Summary

Introduction

Nepal has committed to the global community to achieve universal health coverage by 2030. Nepal still has a high proportion of out-of-pocket health payment and a limited risk-pooling mechanism. Millions of households struggle to finance their healthcare expenses and many of them are driven below the poverty line by such expenses [1, 2]. This struggle for healthcare expenditure is more pronounced in lowincome countries where the health system is poorly funded. In those health systems, measures to protect households financially from healthcare expenditure, such as risk-pooling mechanisms, are either absent or inadequate [3]. Households incurring CHE are likely to compromise their children’s education [8], sell assets [9], and pushed into poverty [10]

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