Incidence of catastrophic health expenditures for households: An example of medical attention for the treatment of severe childhood malaria in Kinshasa reference hospitals, Democratic Republic of Congo

Abstract

This study aimed to estimate the incidence of catastrophic health expenditures faced by households in Kinshasa with children affected by severe malaria. A total of 1350 children below the age of 15 year who were hospitalized due to severe malaria were included in the study. We analyzed the incidence of households facing catastrophic expenditures according to two thresholds: 40% of the household's capacity to pay and 10% of the household's total consumption. Based on the '40% of the capacity to pay' threshold, the incidence of catastrophic health expenditures reached 81.1%, and this estimate reached 46.4% for the '10% above total consumption' threshold. Regarding the ≥ 40% capacity to pay threshold, the incidences of catastrophic expenditures was higher among households with children who were admitted to state hospitals (adjusted odds ratio [aOR] 3.7) and private hospitals (aOR 59.1), for poor households (aOR 13), for households with medium socioeconomic statuses (aOR 3.2), for female-headed households (aOR 2.9), for households with children affected by the neurological form (aOR 4.8) and respiratory distress (aOR 3.6), and for households who opted for a pre-hospital resort (aOR 2.7). Similar results were obtained when the 10% above the total consumption threshold was applied. Greater government financing of medical attention would lead to a reduction in the catastrophic health expenditures faced by the poorest households.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

“…Our findings are consistent with the results of other studies reporting that the risk of catastrophic health expenditures was strongly associated with the type of hospitals that patients have access to utilization of healthcare [29]. Our results are consistent with similar findings from another study that showed that the burden of OOP payments was highest among the poor [30], but a high incidence of catastrophic health expenditures has also been found among poor income households [31]. This may reflect the severity of disease in the poor (low-income) groups, which may be greater than in the high-income groups.…”

Understanding variations in catastrophic health expenditure, its underlying determinants and impoverishment in Sub-Saharan African countries: a scoping review

“…Inpatient HIV patients in Nigeria had the highest incidence of CHE (100%) at 10% household expenditure, while at 40% non-food expenditure, the incidence was reduced to 94.3% [ 38 ]. There was a high incidence of CHE at 40% non-food expenditure in the Democratic republic of Congo amongst hospitalised children with severe malaria which was at 81.1% capacity to pay [ 39 ]. Both studies with a high incidence targeted specific groups of patients and thus were not national representative surveys.…”

“…Households’ income level is the most consistent determinant of catastrophic health expenditure with higher-income groups being less likely to incur CHE relative to middle income- and lower-income groups [ 39 , 43 , 44 ]. This is also observed amongst HIV/ART related studies.…”

“…Within the public health care system, seeking services at the primary health care level like health centres and posts had a reducing effect on CHE [ 30 , 49 ]. In some countries, seeking care from a private health facility is associated with increased CHE relative to seeking care at public facility [ 50 ], while in others, seeking care from public and private is associated with higher CHE compared to confessional structures [ 39 ]. Seeking services from traditional healers due to cultural beliefs on various illnesses is associated with high CHE [ 51 ].…”

Health Insecurity and Social Protection: Pathways, Gaps, and Their Implications on Health Outcomes and Poverty

“…This paper has three main aims: first, to provide a debate on the potential of social protection contribution to addressing health insecurity, poverty, and vulnerability brought by healthcare expenditure in low-income countries. [19][20][21] Second, to explore the gaps in current and proposed social protection measures in healthcare, and third, to provide suggestions on how social protection intervention aimed at addressing health insecurity, poverty, and vulnerability may be effectively implemented. Unlike a standard and structured review paper, in this paper we adopted the approach in debate articles, where a convenience sample of the literature is reviewed and cited accordingly to inform the debate.…”