Abstract
ObjectiveThe purpose and objective of our research is to identify the determinants of the out of pocket (OOP) health expenditures in the population of Ivory Coast and the ratios across three different area; Abidjan, the rural and urban area. We used data from the 2015 standard households living survey conducted by the National Institute of Statistic.ResultsAbout 6315 (13.3%) of the participants had experienced OOP health expenditure. There was significant differences in the self-reported OOP between these three areas (p < 0.001). The overall mean of OOP expenditure among all participants was 16,034.33 XOF (29 USD). People in Abidjan spent an average of 1.6 and 1.5 times more than those in the rural and urban areas respectively (p < 0.001). Hospitalization is the highest expenditure item in terms of money spent, while drugs are the most common item of expenditure in terms of frequency, regardless of the place of residence. Female gender, high social economic status and large household size increase OOP health expenditure significantly in all areas of residence when insurance reduce it. To reduce the impact of the direct payments there is a need to take into account social demographic factors in addition to economic factor in health policy development.
Highlights
In the low and middle income countries, health expenditures are financed mainly by households through direct payments [1, 2]
In Côte d’Ivoire, direct payments accounted for 32.55% of current health expenditure in 2015 [12]
People living in Abidjan has reported more frequently out of pocket (OOP) expenditure: Rural 3311 (12.5%), Urban 2296 (13.9%) and Abidjan 708 (15.2%)
Summary
About 6315 (13.3%) of the 47,635 participants had experienced OOP health expenditure within the last 3 months. Comparing the three areas of residence, health expenditures from the orthodox medical system was higher in Abidjan; while average spending on traditional medicines in rural and urban areas was 8 times more than that in Abidjan. By comparing the three areas of residence, OOP health expenditure was highest in Abidjan in most of the variables e.g. sex, age, marital status, household size, insurance or financial aid for treatment expenses (Additional file 1). Multivariate analysis (Table 3) indicated that gender, marital status, quintiles of expenditure, being included in a large household size and being insured or receiving financial aid were significant predictors of OOP health expenditure. There was no statistically significant difference between the OOP expenditures of individuals living in Abidjan and other areas of residence The existence of a chronic disease was not a predictor of OOP expenditures
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