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Catastrophic household expenditure on health in Nepal: a cross-sectional survey

OBJECTIVE: To determine the incidence of – and illnesses commonly associated with – catastrophic household expenditure on health in Nepal. METHODS: We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household s...

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Autores principales: Saito, Eiko, Gilmour, Stuart, Rahman, Md Mizanur, Gautam, Ghan Shyam, Shrestha, Pradeep Krishna, Shibuya, Kenji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: World Health Organization 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208475/
https://www.ncbi.nlm.nih.gov/pubmed/25378730
http://dx.doi.org/10.2471/BLT.13.126615
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author Saito, Eiko
Gilmour, Stuart
Rahman, Md Mizanur
Gautam, Ghan Shyam
Shrestha, Pradeep Krishna
Shibuya, Kenji
author_facet Saito, Eiko
Gilmour, Stuart
Rahman, Md Mizanur
Gautam, Ghan Shyam
Shrestha, Pradeep Krishna
Shibuya, Kenji
author_sort Saito, Eiko
collection PubMed
description OBJECTIVE: To determine the incidence of – and illnesses commonly associated with – catastrophic household expenditure on health in Nepal. METHODS: We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household’s total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. FINDINGS: Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease. CONCLUSION: In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.
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spelling pubmed-42084752014-11-06 Catastrophic household expenditure on health in Nepal: a cross-sectional survey Saito, Eiko Gilmour, Stuart Rahman, Md Mizanur Gautam, Ghan Shyam Shrestha, Pradeep Krishna Shibuya, Kenji Bull World Health Organ Research OBJECTIVE: To determine the incidence of – and illnesses commonly associated with – catastrophic household expenditure on health in Nepal. METHODS: We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household’s total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. FINDINGS: Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease. CONCLUSION: In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure. World Health Organization 2014-10-01 2014-08-20 /pmc/articles/PMC4208475/ /pubmed/25378730 http://dx.doi.org/10.2471/BLT.13.126615 Text en (c) 2014 The authors; licensee World Health Organization. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
spellingShingle Research
Saito, Eiko
Gilmour, Stuart
Rahman, Md Mizanur
Gautam, Ghan Shyam
Shrestha, Pradeep Krishna
Shibuya, Kenji
Catastrophic household expenditure on health in Nepal: a cross-sectional survey
title Catastrophic household expenditure on health in Nepal: a cross-sectional survey
title_full Catastrophic household expenditure on health in Nepal: a cross-sectional survey
title_fullStr Catastrophic household expenditure on health in Nepal: a cross-sectional survey
title_full_unstemmed Catastrophic household expenditure on health in Nepal: a cross-sectional survey
title_short Catastrophic household expenditure on health in Nepal: a cross-sectional survey
title_sort catastrophic household expenditure on health in nepal: a cross-sectional survey
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208475/
https://www.ncbi.nlm.nih.gov/pubmed/25378730
http://dx.doi.org/10.2471/BLT.13.126615
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