Magnitude and Determinants of out of pocket medical expenditure among outpatients visiting public hospitals in East Shoa zone of Oromia region

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Addis Abeba University


Background: Out of pocket expenditure at the point of health service delivery increases the likelihood of catastrophic financial expenditures for health service users. In Ethiopia, around 33.7% of total health expenditure comes from the household out-of-pocket expenditure. Such significant out of -pocket payment creates financial barriers to access to health services and puts people at risk of poverty. Therefore, this finding offers new evidence on the magnitude and determinants of out of pocket expenditure on out-patient care. Objectives: To investigate the magnitude and determinants of Out-of-Pocket medical expenditure among outpatients visiting Hospitals in East Shoa Zone, Oromia, Ethiopia. Methods: An institution based cross-sectional study was conducted on 422 participants visited public hospitals in East Shoa zone from February 18 to Murch 9, 2019. Data collection took place through interviews with patients coming to the outpatient pharmacy after finishing their visits at the different outpatient departments in the hospitals. Data were collected via structured questioner, then it was cleaned, coded, entered into EPI info 7 and exported to SPSS version 23 statistical package for analysis. Descriptive statistics and both bivariate and multivariable logistic regression were used to identify determinants of OOP. The existence of association was measured using odds ratio with 95% confidence intervals. Results: From the 378 interviews included in the final analysis, the proportion of participants paid out-of-pocket medical expenditure was 332(87.8%) and the mean out-of-pocket medical expenditure was 351.48 ETB (12.55USD) per visit, while the direct medical cost was 132.86 ETB. In addition, the study identifies some significant determinants for the out-of-pocket medical expenses of OPD services namely, residence, education of the household head and sex of the households. Conclusion: - Most of the study participants were pay OOPME with the high average for OPD service received which is high when compared with the mean monthly household per capita income and OOPME found to determine by residence, educational level of household head and sex of the household. Health managers should focus on the implementation of CBHI and start SHI in order to protect society from financial risk that occurred at the service delivery.



Out-of-pocket medical expenditures, health insurance, socioeconomic determinants of health, Catastrophic health expenditure.