Catastrophic health expenditure and associated factors among households of non cbhi districts, ilubabor zone, oromia national regional state, south west Ethiopia

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.