Incidence, socio-economic inequalities and determinants of catastrophic health expenditure and impoverishment for diabetes care in South Africa: a study at two public hospitals in Tshwane

International Journal for Equity in Health

Charles Hongoro¹  Chipo Mutyambizi²  Milena Pavlova³  Wim Groot³  Frederik Booysen⁴ 

[1] 0000 0001 0071 1142, grid.417715.1, Research Use and Impact Assessment, Human Sciences Research Council, HSRC Building, 134 Pretorius Street, 0002, Pretoria, South Africa;0000 0001 0071 1142, grid.417715.1, Research Use and Impact Assessment, Human Sciences Research Council, HSRC Building, 134 Pretorius Street, 0002, Pretoria, South Africa;0000 0001 0481 6099, grid.5012.6, Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands;0000 0001 0481 6099, grid.5012.6, Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands;0000 0004 1937 1135, grid.11951.3d, School of Economic and Business Sciences, University of the Witwatersrand, Johannesburg, South Africa;

关键词: Diabetes;    Catastrophic health expenditure;    Impoverishment;    Inequality;    South Africa;   

DOI  :  10.1186/s12939-019-0977-3

来源: publisher

【 摘 要 】

BackgroundDirect out of pocket (OOP) payments for healthcare may cause financial hardship. For diabetic patients who require frequent visits to health centres, this is of concern as OOP payments may limit access to healthcare. This study assesses the incidence, socio-economic inequalities and determinants of catastrophic health expenditure and impoverishment amongst diabetic patients in South Africa.MethodsData were taken from a cross-sectional survey conducted in 2017 at two public hospitals in Tshwane, South Africa (N = 396). Healthcare costs and transport costs related to diabetes care were classified as catastrophic if they exceeded the 10% threshold of household’s capacity to pay (WHO standard method) or if they exceeded a variable threshold of total household expenditure (Ataguba method). Erreygers concentration indices (CIs) were used to assess socio-economic inequalities. A multivariate logistic regression was applied to identify the determinants of catastrophic health expenditure and impoverishment.ResultsTransport costs contributed to over 50% of total healthcare costs. The incidence of catastrophic health expenditure was 25% when measured at a 10% threshold of capacity to pay and 13% when measured at a variable threshold of total household expenditure. Depending on the method used, the incidence of impoverishment varied from 2 to 4% and the concentration index for catastrophic health expenditure varied from − 0.2299 to − 0.1026. When measured at a 10% threshold of capacity to pay factors associated with catastrophic health expenditure were being female (Odds Ratio 1.73; Standard Error 0.51), being within the 3rd (0.49; 0.20), 4th (0.31; 0.15) and 5th wealth quintile (0.30; 0.17). When measured using a variable threshold of total household expenditure factors associated with catastrophic health expenditure were not having children (3.35; 1.82) and the 4th wealth quintile (0.32; 0.21).ConclusionFinancial protection of diabetic patients in public hospitals is limited. This observation suggests that health financing interventions amongst diabetic patients should target the poor and poor women in particular. There is also a need for targeted interventions to improve access to healthcare facilities for diabetic patients and to reduce the financial impact of transport costs when seeking healthcare. This is particularly important for the achievement of universal health coverage in South Africa.

【 授权许可】

CC BY