Out-of-pocket expenditure for hypertension care: a population-based study in low-income urban Medellin, Colombia

Esteban Londoño Agudelo,Anaí García Fariñas,Viviana Pérez Ospina,Cecilia Taborda Pérez,Tatiana Villacrés Landeta,Tullia Battaglioli,Rubén Gómez Arias,Patrick Van Der Stuyft

doi:10.1080/16549716.2020.1806527

Abstract

ABSTRACT Background Hypertension requires life-long medical care, which may cause economic burden and even lead to catastrophic health expenditure. Objective To estimate the extent of out-of-pocket expenditure for hypertension care at a population level and its impact on households’ budgets in a low-income urban setting in Colombia. Methods We conducted a cross-sectional survey in Santa Cruz, a commune in the city of Medellin. In 410 randomly selected households with a hypertensive adult, we estimated annual basic household expenditure and hypertension-attributable out-of-pocket expenditure. For socioeconomic stratification, we categorised households according to basic expenditure quintiles. Catastrophic hypertension-attributable expenditure was defined as out-of-pocket expenditure above 10% of total household expenditure. Results The average annual basic household expenditure was US dollars at purchasing power parity (USD-PPP) $12,255.59. The average annual hypertension-attributable out-of-pocket expenditure was USD-PPP $147.75 (95% CI 120.93–174.52). It was incurred by 73.9% (95% CI 69.4%-78.1%) of patients, and consisted mainly of direct non-medical expenses (76.7%), predominantly for dietary requirements prescribed as non-pharmacological treatment and for transport to attend health care consultations. Medical out-of-pocket expenditure (23.3%) was for the most part incurred for pharmacological treatment. Hypertension-attributable out-of-pocket expenditure represented on average 1.6% (95% CI 1.3%-1.9%) of the total annual basic household expenditure. Eight households (2.0%; 95% CI 1.0%-3.8%) had catastrophic health expenditure; six of them belonged to the two lowest expenditure quintiles. Payments related to dietary requirements and transport to consultations were critical determinants of their catastrophic expenditure. Conclusions Out-of-pocket expenditure for hypertension care is moderate on average, but frequent, and mainly made up of direct non-medical expenses. Catastrophic health expenditure is uncommon and affects primarily households in the bottom socioeconomic quintiles. Financial protection should be strengthened by covering the costs of chronic diseases-related dietary requirements and transport to health services in the most deprived households. Abbreviations NCDs: Non-communicable diseases; LMICs: Low and middle-income countries; WHO: World Health Organization; HTN: hypertension; CVDs: Cardiovascular diseases; OOPE: out-of-pocket expenditure; USD-PPP: US dollars at purchasing power parity; CI: Confidence interval

Highlights

Hypertension requires life-long medical care, which may cause economic burden and even lead to catastrophic health expenditure
The average annual basic household expenditure was US dollars at purchasing power parity (USD-PPP) 12,255.59, 41.5% of which went to food (Table 1)
We found high variability and a right-skewed distribution for all expenditure components, but their means and medians were generally comparable in both insurance schemes

Summary

Introduction

Hypertension requires life-long medical care, which may cause economic burden and even lead to catastrophic health expenditure. Catastrophic hypertension-attributable expenditure was defined as out-of-pocket expen diture above 10% of total household expenditure. The average annual hypertension-attributable out-of-pocket expenditure was USD-PPP $147.75 (95% CI 120.93–174.52). It was incurred by 73.9% (95% CI 69.4%-78.1%) of patients, and consisted mainly of direct non-medical expenses (76.7%), pre dominantly for dietary requirements prescribed as non-pharmacological treatment and for transport to attend health care consultations. Hypertension-attributable out-ofpocket expenditure represented on average 1.6% (95% CI 1.3%-1.9%) of the total annual basic household expenditure. Conclusions: Out-of-pocket expenditure for hypertension care is moderate on average, but frequent, and mainly made up of direct non-medical expenses. In Latin America and the Caribbean alone, 1.6 million people die from CVDs every year (38% of all deaths), half a million of them before 70 years

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