Catastrophic Health Expenditure and Impoverishment from Non- Communicable Diseases: A comparison of Private and Public Health Facilities in Ekiti State, Southwest Nigeria

Abstract

Background: Catastrophic health expenditure and impoverishment are the outcomes of poor financing mechanisms. Little is known about the  prevalence and predictors of these outcomes among non-communicable disease patients in private and public health facilities.

Methods: A health facility-based comparative cross-sectional study was conducted among 360 patients with non-communicable diseases (180 per  group) selected through multistage sampling. Data were collected with a semi-structured, intervieweradministered questionnaire and analyzed with  IBM SPSS for Windows, Version 22.0. Two prevalences of catastrophic health expenditure were calculated utilizing both the World Bank (CHE1)  and the WHO (CHE2) methodological thresholds.

Results: The prevalence of CHE1 (Private:42.2%, Public:21.7%, p<0.001) and CHE2 (Private:46.8%, Public:28.0%, p<0.001) were higher in private  health facilities. However, there was no significant difference between the proportion of impoverishment (Private:24.3%, Public:30.9%, p=0.170). The  identified predictors were occupation, number of complications and clinic visits for catastrophic health expenditure and socioeconomic status for  impoverishment in private health facilities. Level of education, occupation, socioeconomic status, number of complications and alcohol predicted  catastrophic health expenditure while the level of education, socioeconomic status and the number of admissions predicted impoverishment in  public health facilities.

Conclusion: Catastrophic health expenditure and impoverishment were high among the patients, with the former more prevalent in private health  facilities. Therefore, we recommend expanding the coverage and scope of national health insurance among these patients to provide them with  financial risk protection. Identified predictors should be taken into account by the government and other stakeholders when designing policies to  limit catastrophic health expenditure and impoverishment among them.