Out-of-pocket expenditure for cardiovascular disease care in general and specialized hospitals in Addis Ababa, Ethiopia. Birmingham, September 2016

Transcription

1 Out-of-pocket expenditure for cardiovascular disease care in general and specialized hospitals in Addis Ababa, Ethiopia Mieraf Taddesse 1, Ole Frithjof Norheim 1,2, Stéphane Verguet 2, Abebe Belayneh 3, Kassahun Amenu 3, Senbeta Guteta 4, Kjell Arne Johansson 1,5 Birmingham, September Department of global public health and primary care, University of Bergen, Norway, 2 Harvard T.H. Chan School of Public Health, Boston, USA, 3 Ethiopian Public Health Institute, Addis Ababa, Ethiopia, 4 Addis Ababa University, School of Medicine, Department of Internal Medicine, Ethiopia, 5 Department of Drug Addiction, Haukeland University Hospital, Bergen G L O B A L H E A L T H P R I O R I T I E S

2 OUTLINE Background Objectives Methods Results Conclusions

3 BACKGROUND Ensure financial risk protection to households under the umbrella of Universal health coverage Health systems financing: out-of-pocket payments Chronic diseases e.g in India households with a member having cardiovascular disease paid 16% more of their annual income on health care MFC-UHC WHO 2013 HSF-UHC-WHO 2010 WAGSTAFF ET AL 2008 KARAN 2014 XU KE 2003

4 per-capita spending on health in US $ HEALTH FINANCING IN ETHIOPIA Annual spending on health in Ethiopia / / / / /11 Government Household Rest of the world Other Ethiopian National health accounts I-V( /11) World Bank Ethiopia country data sheer 2015 Ethiopia world health survey 2003

5 CARDIOVASCULAR DISEASE BURDEN Causes of mortality in Addis Ababa ( ) WHO Ethiopia country profile 2014 Tesfaye et al 2008, Awoke et al 2012

6 OBJECTIVES Estimate the magnitude and intensity of catastrophic health expenditure related to accessing prevention and treatment services for cardiovascular disease in general and specialized hospitals in Addis Ababa, Ethiopia Assess factors associated with catastrophic health expenditure for cardiovascular disease care

7 METHODS Study design and population Outcome metrics Data analysis Ethical considerations

8 RESULTS

9 Magnitude of catastrophic health expenditure(che) 27% of households suffered catastrophic health expenditure [95% CI (23%, 31%), n=589] The poorer households were affected more The magnitude of catastrophic health expenditure dropped to 8% when adjusting for sources of finance

10 FACTORS ASSOCIATED WITH CHE Covariates Bivariate models OR [95% CI] p-value Residence Addis Ababa 1 Outside Addis 2.1 [ ] 0.00 Type of hospital Public 1 Private 3.1 [ ] 0.00 Hospitalization No 1 Yes 8.2 [ ] 0.00 CVD event No 1 Yes 2.2 [ ] 0.00 Family size Family size 1.1 [ ] 0.00 OR = odds ratio

11 FACTORS ASSOCIATED WITH CHE Income quintile Adjusted odds ratios* OR [95% CI] p-value Q1 (poorest) 47.9 [ ] 0.00 Q [ ] 0.00 Q [ ] 0.00 Q4 6.3 [ ] 0.00 Q5 (richest) 1 OR = odds ratio * Adjusted for residence, type of hospital visited, history of hospitalization, diagnosis and family size

12 INTENSITY OF CHE Mean positive overshoot(%) Income quintile Mean SE [95% CI] Total [ ] Q1 (poorest) [ ] Q [ ] Q [ ] Q [ ] Q5 (richest) [ ] Mean positive overshoot: average share (%) household that suffered CHE (>10% household s income threshold) spend on cardiovascular disease care relative to income

13 Proportion of cost items relative to out-patient care expenditure COSTS ITEMS BY HOSPITAL TYPE ,7 1,9 Consultation fee 54,5 44,2 Drugs Public hospitals 8,8 24,2 Lab and imaging 29,4 Transport Private hospitals 11 4,9 5 Others

14 STRENGTH AND LIMITATIONS First study to estimate the magnitude of CHE related to accessing cardiovascular disease care in Ethiopia Self-reported data on out-of-pocket expenditure and income Hospital-based and not household based

15 CONCLUSIONS Poorest households were about 50 times more likely to suffer CHE compared with richest households Seeking care in private hospitals tripled the odds of suffering CHE whereas residence outside Addis Ababa doubled the odds compared with public hospital and Addis Ababa respectively Drugs and transport costs constitute about 50 percent and 20 percent of out-patient care expenditure respectively

16 Thank you