Abstract:
Background: Out-of-pocket health expenditure is the proportion of total health expenditure that is
paid by individuals and households at the time health service. According to World Bank report, OOP
expenditure in Ethiopia was at 33.7% which is against the recommended OOP payment which is lower
than in other Sub Saharan Africa countries (62.2 %).
Objective: To assess the incidence and intensity of catastrophic health expenditure and associated
factors among households of non CBH districts, Ilubabor zone, Oromia National Regional state,
Ethiopia.
Methods: Community based cross-sectional study design was carried out. The study was conducted
from mid-year 2017 to mid- 2018 to include all expenditures by households for health during one-year
period. Out of seven non community based health insurance scheme district three district was included
in the study multistage sampling was employed. During stage one clustering sampling method was used
to select three district. Data was collected by using structured mix of open and close-ended pre -tested
questionnaire by face to face interviewing of respondents from 334 households in August 2018 by
trained diploma holder and above health professionals who can speak, write and read local languages.
Micro-costing/bottom up approach was used to all household expenditure. To assess the incidence and
intensity of catastrophic health expenditure, all household consumption expenditure was done by
mathematical analysis using Microsoft excel . The predictors of catastrophic health expenditure was
done by binary logistic regression analysis and all significant p<0.25 variables were candidate for multi
logistic analysis and the finally, P<0.05 was used as significant level.
Results: The number of households which participated in the study were 333 with response rate of
99.7%. Out of 333 household surveyed 58 (17.4%) of them were in catastrophe which exceeds 10% of
total household expenditure and after medical care expenses about 17(5%) the house hold moved
downward from middle poverty line to extreme poverty. Factors significantly associated were, family
size, out of pocket payment, average daily income distance from health facility, Ambulance service and
chronic disease
Conclusion and recommendation: Among the predictors considered family size, average daily
income, out of pocket payment and chronic diseases were statistically significant and independent
predictors household catastrophic health expenditure. To overcome financial risk, Federal ministry of
health should develop different guidelines and modalities by considering the household per capita and
income to improve the enrolment of community based health insurance. Also regional health bureau
should improve budget share of 10% for to increase the coverage of poor households.
