Assessing the burden of medical impoverishment by cause: a systematic breakdown by disease in Ethiopia

BMC Medicine

Research Article

Stéphane Verguet¹  Ole Frithjof Norheim²  Solomon Tessema Memirie³ 

[1] Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, 02115, Boston, MA, USA;Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, 02115, Boston, MA, USA;Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;

关键词: Medical impoverishment;    Catastrophic health expenditure;    Out-of-pocket costs;    Direct medical payments;    Financial risk protection;    Poverty;    Ethiopia;   

DOI  :  10.1186/s12916-016-0697-0

 received in 2016-04-01, accepted in 2016-09-16,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundOut-of-pocket (OOP) medical expenses often lead to catastrophic expenditure and impoverishment in low- and middle-income countries. Yet, there has been no systematic examination of which specific diseases and conditions (e.g., tuberculosis, cardiovascular disease) drive medical impoverishment, defined as OOP direct medical costs pushing households into poverty.MethodsWe used a cost and epidemiological model to propose an assessment of the burden of medical impoverishment in Ethiopia, i.e., the number of households crossing a poverty line due to excessive OOP direct medical expenses. We utilized disease-specific mortality estimates from the Global Burden of Disease study, epidemiological and cost inputs from surveys, and secondary data from the literature to produce a count of poverty cases due to OOP direct medical costs per specific condition.ResultsIn Ethiopia, in 2013, and among 20 leading causes of mortality, we estimated the burden of impoverishment due to OOP direct medical costs to be of about 350,000 poverty cases. The top three causes of medical impoverishment were diarrhea, lower respiratory infections, and road injury, accounting for 75 % of all poverty cases.ConclusionsWe present a preliminary attempt for the estimation of the burden of medical impoverishment by cause for high mortality conditions. In Ethiopia, medical impoverishment was notably associated with illness occurrence and health services utilization. Although currently used estimates are sensitive to health services utilization, a systematic breakdown of impoverishment due to OOP direct medical costs by cause can provide important information for the promotion of financial risk protection and equity, and subsequent design of health policies toward universal health coverage, reduction of direct OOP payments, and poverty alleviation.

【 授权许可】

CC BY   
© The Author(s). 2016