Abstract
BackgroundDirect out of pocket (OOP) payments for healthcare may cause financial hardship. For diabetic patients who require frequent visits to health centres, this is of concern as OOP payments may limit access to healthcare. This study assesses the incidence, socio-economic inequalities and determinants of catastrophic health expenditure and impoverishment amongst diabetic patients in South Africa.MethodsData were taken from a cross-sectional survey conducted in 2017 at two public hospitals in Tshwane, South Africa (N = 396). Healthcare costs and transport costs related to diabetes care were classified as catastrophic if they exceeded the 10% threshold of household’s capacity to pay (WHO standard method) or if they exceeded a variable threshold of total household expenditure (Ataguba method). Erreygers concentration indices (CIs) were used to assess socio-economic inequalities. A multivariate logistic regression was applied to identify the determinants of catastrophic health expenditure and impoverishment.ResultsTransport costs contributed to over 50% of total healthcare costs. The incidence of catastrophic health expenditure was 25% when measured at a 10% threshold of capacity to pay and 13% when measured at a variable threshold of total household expenditure. Depending on the method used, the incidence of impoverishment varied from 2 to 4% and the concentration index for catastrophic health expenditure varied from − 0.2299 to − 0.1026. When measured at a 10% threshold of capacity to pay factors associated with catastrophic health expenditure were being female (Odds Ratio 1.73; Standard Error 0.51), being within the 3rd (0.49; 0.20), 4th (0.31; 0.15) and 5th wealth quintile (0.30; 0.17). When measured using a variable threshold of total household expenditure factors associated with catastrophic health expenditure were not having children (3.35; 1.82) and the 4th wealth quintile (0.32; 0.21).ConclusionFinancial protection of diabetic patients in public hospitals is limited. This observation suggests that health financing interventions amongst diabetic patients should target the poor and poor women in particular. There is also a need for targeted interventions to improve access to healthcare facilities for diabetic patients and to reduce the financial impact of transport costs when seeking healthcare. This is particularly important for the achievement of universal health coverage in South Africa.
Highlights
Direct out of pocket (OOP) payments for healthcare may cause financial hardship
It is reported that catastrophic health expenditure and impoverishment is high in countries in which OOP payments for healthcare are above 20% of total health expenditure (THE) [2]
As expected, when we included transport costs in estimating the ratio of healthcare costs to capacity to pay, we find that catastrophic health expenditure measured at all four thresholds was much higher than when we exclude transport costs
Summary
Study setting This study was done in Tshwane, one of the 5 districts in the province of Gauteng, which is the most populous province in South Africa. Questionnaire Questionnaire development was guided by the South African National Health and Nutrition Examination Survey data collection tool [28] and previous hospital based studies that estimated catastrophic health expenditure [18, 29]. Step 9: A household is defined as poor if its THEh was smaller than its SEh and non-poor when THEh was greater than or equal to SEh. Step 10: A non-poor household was considered impoverished by healthcare payments once it became poor after paying for healthcare impovh 1⁄4 1 if THEh−OOPHEh < SEh impovh 1⁄4 0 if THEh−OOPHEh > SEh. In order to check the robustness of our results and due to the limitations of the WHO standard method outlined above, we estimated catastrophic health expenditure using the method proposed by Ataguba et al [34].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
