G L O B A L H E A L T H P R I O R I T I E S

Mieraf Taddesse1

, Ole Frithjof Norheim1,2, Stéphane Verguet 2, Abebe Belayneh3,

Kassahun Amenu3, Senbeta Guteta4, Kjell Arne Johansson1,5

Out-of-pocket expenditure for cardiovascular disease

care in general and specialized hospitals in Addis Ababa,

Ethiopia

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1Department 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

Birmingham, September 2016

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OUTLINE

Background

Objectives

Methods

Results

Conclusions

GLOBAL HEALTH PRIORITIES

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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

GLOBAL HEALTH PRIORITIES

MFC-UHC WHO 2013

HSF-UHC-WHO 2010

WAGSTAFF ET AL 2008

KARAN 2014

XU KE 2003

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HEALTH FINANCING IN ETHIOPIA

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0

5

10

15

20

25

1995/96 1999/00 2004/05 2007/08 2010/11per

-cap

ita

spen

din

g o

n h

ealt

h i

n

US

$

Annual spending on health in Ethiopia

Government Household Rest of the world Other

16.1

7.1

20.7

5.64.1

Ethiopian National health accounts I-V(1994-

2010/11)

World Bank Ethiopia country data sheer 2015

Ethiopia world health survey 2003

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CARDIOVASCULAR DISEASE BURDEN

Causes of mortality in Addis Ababa (2006-2009)

GLOBAL HEALTH PRIORITIES

WHO Ethiopia country profile 2014 Tesfaye et al 2008, Awoke et al 2012

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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

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METHODS

Study design and population

Outcome metrics

Data analysis

Ethical considerations

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RESULTS

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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

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Covariates Bivariate models

OR [95% CI] p-value

Residence Addis Ababa 1

Outside Addis 2.1 [1.4 3.3] 0.00

Type of hospital Public 1

Private 3.1 [2.1 4.5] 0.00

Hospitalization No 1

Yes 8.2 [5.1 13.1] 0.00

CVD event No 1

Yes 2.2 [1.5 3.1] 0.00

Family size Family size 1.1 [1.1 1.3] 0.00

FACTORS ASSOCIATED WITH CHE

OR = odds ratio

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Income quintile Adjusted odds ratios*

OR [95% CI] p-value

Q1 (poorest) 47.9 [16.2 141.8] 0.00

Q2 43.2 [16.0 117.2] 0.00

Q3 21.9 [8.3 57.8] 0.00

Q4 6.3 [2.6 15.4] 0.00

Q5 (richest) 1

FACTORS ASSOCIATED WITH CHE

OR = odds ratio

* Adjusted for residence, type of hospital visited, history of hospitalization, diagnosis and family size

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Income quintile Mean positive overshoot(%)

Mean SE [95% CI]

Total 17.6 2.2 [13.1 22.1]

Q1 (poorest) 23.6 5.2 [13.4 33.9]

Q2 23.9 6.7 [10.6 37.1]

Q3 14.0 2.6 [8.8 19.2]

Q4 12.9 2.4 [8.2 17.6]

Q5 (richest) 4.8 1.2 [2.4 7.1]

INTENSITY OF CHE

Mean positive overshoot: average share (%) household that suffered CHE (>10%

household’s income threshold) spend on cardiovascular disease care relative to income

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1,9

54,5

8,8

29,4

4,914,7

44,2

24,2

11 50

10

20

30

40

50

60

Consultation

fee

Drugs Lab and

imaging

Transport OthersPro

port

ion

of

cost

ite

ms

rela

tive

to o

ut-

pati

ent

care

exp

end

itu

re

Public hospitals Private hospitals

COSTS ITEMS BY HOSPITAL TYPE

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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

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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

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Thank you

GLOBAL HEALTH PRIORITIES