Risk Management and Healthcare Policy (Mar 2024)
Catastrophic Health Expenditure and Associated Factors Among Hospitalized Cancer Patients in Addis Ababa, Ethiopia
Abstract
Girum Yihun Matebie,1,2 Anagaw Derseh Mebratie,1 Tamiru Demeke,1,2 Bezawit Afework,3 Eva J Kantelhardt,2 Adamu Addissie1,2 1School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Global Health Working Group, Medical Faculty Martin-Luther-University Halle-Wittenberg, Wittenberg, Germany; 3Department of Midwifery, College of Medicine and Health Science, Arba Minch University, Arba Minch, EthiopiaCorrespondence: Girum Yihun Matebie, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, P.o Box 9086, Tel +251910474367, Fax +251115157701, Email [email protected]: Out-of-pocket (OOP) health expenditures for cancer care expose households to unanticipated economic consequences. When the available health services are mainly dependent on OOP expenditure, the household faces catastrophic health expenditure (CHE). This study aimed to estimate the incidence and intensity of CHE in hospitalized cancer patients and identify coping strategies and associated factors.Method and Material: Hospital-based cross-sectional study design was conducted on 305 cancer inpatients in Addis Ababa between November 2021 and February 2022. All patients with cancer who were hospitalized during the data collection period were included in the study. The incidence of CHE was estimated at the 40% threshold of households’ non-food expenditure and the intensity of CHE was captured based on the amount by which household expenditure exceeded the threshold and mean positive overshoot, the mean level by which CHE exceeds the threshold used. Multivariate logistic regression was used to assess the relationship between CHE levels and the independent variables.Results: The incidence of CHE at the 40% threshold of households’ non-food expenditure was 77.7%, while the O and MPO were 36.2% and 46.6%, respectively. CHE for cancer care was significantly associated with patient residence, increased number of chemotherapy cycles, increased duration of hospital admission, lack of insurance enrolment, and lower-income quintiles. Saving and selling assets were identified as the primary coping mechanisms.Conclusion: The incidence and intensity of CHE among inpatients with cancer were high and which could lead to impoverishment of households. Improved quality and coverage of health insurance and decentralizing cancer care to regions standards similar to Addis Ababa will save households from incurring CHE.Keywords: catastrophic out-of-pocket health expenditure, coping mechanisms, cancer, Ethiopia
