Out-of-pocket expenditure for hypertension care: a population-based study in low-income urban Medellin, Colombia

Abstract

Background: Hypertension requires lifelong medical care, which may cause economic burden and even lead to catastrophic health expenditure. Objective: To estimate the extent of out-of-pocket expenditure for hypertension care at a population level and its impact on households' budgets in a low-income urban setting in Colombia. Methods: We conducted a cross-sectional survey in Santa Cruz, a commune in the city of Medellin. In 410 randomly selected households with a hypertensive adult, we estimated annual basic household expenditure and hypertension-attributable out-of-pocket expenditure. For socioeconomic stratification, we categorised households according to basic expenditure quintiles. Catastrophic hypertension-attributable expenditure was defined as out-of-pocket expenditure above 10% of total household expenditure. Results: The average annual basic household expenditure was US dollars at purchasing power parity (USD-PPP) $12,255.59. The average annual hypertension-attributable out-of-pocket expenditure was USD-PPP $147.75 (95% CI 120.93-174.52). It was incurred by 73.9% (95% CI 69.4%-78.1%) of patients, and consisted mainly of direct non-medical expenses (76.7%), predominantly for dietary requirements prescribed as non-pharmacological treatment and for transport to attend health care consultations. Medical out-of-pocket expenditure (23.3%) was for the most part incurred for pharmacological treatment. Hypertension-attributable out-ofpocket expenditure represented on average 1.6% (95% CI 1.3%-1.9%) of the total annual basic household expenditure. Eight households (2.0%; 95% CI 1.0%-3.8%) had catastrophic health expenditure; six of them belonged to the two lowest expenditure quintiles. Payments related to dietary requirements and transport to consultations were critical determinants of their catastrophic expenditure. Conclusions: Out-of-pocket expenditure for hypertension care is moderate on average, but frequent, and mainly made up of direct non-medical expenses. Catastrophic health expenditure is uncommon and affects primarily households in the bottom socioeconomic quintiles. Financial protection should be strengthened by covering the costs of chronic diseases-related dietary requirements and transport to health services in the most deprived households.

World Heart Federation Roadmap for Hypertension – A 2021 Update

“…It is therefore particularly important to identify and monitor hypertension to reduce the risk among the most vulnerable groups [ 33 34 ]. Dealing with the consequences of hypertension often represents a heavy financial burden for those affected and their families, due to out-of-pocket payments for consultations and medications and to catastrophic costs associated with sequela CVDs (survivors of stroke, heart failure or acute myocardial infarction) and with premature deaths [ 34 35 36 ].…”

Prevalence, awareness, treatment, and control of hypertension in Bissau, Western Africa

“…For example, medications used in the treatment of the main infectious diseases (Malaria, Tuberculosis and HIV) are free of charge, whereas hypertensive patients have to buy antihypertensive drugs with out‐of‐pocket costs – which increases the cost of healthcare and may consequently contribute to poor treatment and control of hypertension. 12 Moreover, it can be extremely challenging for individuals with a low income to continue with the lifelong management of chronic conditions. 13 Most of their available resources are used for basic needs, and healthcare expenses threaten their financial capacity to maintain subsistence.…”

Gaps in hypertension care and control: a population‐based study in low‐income urban Medellin, Colombia

“…As detailed previously [ 15 ], the study was conducted in 2016 in the Santa Cruz Commune, located in the northeast of Medellin, the second‐largest industrialised city of Colombia. Santa Cruz is one of the most deprived of the city’s 16 communes [ 16 ] and had 111 452 inhabitants (53% women and 47% men) in 2015 [ 17 ].…”