Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey

Abstract

BackgroundInequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures.MethodsWe accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects.ResultsIncreasing age, female gender, obesity and functional disability increased the adults’ out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head’s occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer’s visits were significantly associated with high catastrophic health expenditures.ConclusionWe observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare programs and strengthening the social security mechanisms could reduce the financial burden in United Republic of Tanzania.

Health expenditure and catastrophic spending among older adults living with HIV

“…Female-headed households were more likely to experience CHE than male-headed households as were rural households as compared to urban households. This is confirmed by Tanzania data which found that increased age, female sex, obesity, and disability increased adults' OOP health expenditures significantly -and, among older adults specifically (60+), disability and visiting traditional healers increased expenditures (Brinda et al, 2014). In Cote d'Ivoire, sex, duration of ART use, education of the household head, household size and household income quintile were all significant predictors of CHE (Beauliere et al, 2010).…”

“…OOP expenditure is usually in the form of direct payments by households towards various types of health care and in general, OOP health expenditures are high in many countries in Africa and many households experience a high burden of catastrophic health expenditures (CHEs; Brinda, Andres, & Enemark, 2014;Chuma & Maina, 2012;Macha et al, 2012;Mills et al, 2012). In 2009, over 70% of private expenditure on health care came from household OOP payments in 27 African countries (Sambo, Kirigia, & Orem, 2013).…”

The Prevalence and Determinants of Catastrophic Health Expenditures in Iran: A Systematic Review and Meta-Analysis

“…However, out-ofpocket (OOP) payments can influence the equality of access to and utilization of health services and decelerate the movement toward UHC (2). Facing with CHE can influence the health of all household members and may push the households into poverty health cycle (3).…”

Análisis del gasto de los hogares en salud en Argentina, como componente de la cobertura universal de salud

“…Previous studies reported that in 1997 catastrophic spending on healthcare was observed in 5.77% of household in the country 14 , whereas in 2004 this type of spending affected 3.6% of households 15 . Compared to other countries, the spending of argentine households on health-related events may be considered low, since some countries exhibit an incidence of catastrophic spending be- tween 10% and 27% of households, estimated on the basis of a cut-off point of 40% of expenditure exclusive of food ( [16][17][18] ). As to factors that determine household spending on healthcare, those having members below 14 years of age show the highest spending, and the same applies for those having members above 65 years.…”