Catastrophic out of Pocket Expenditure for Cancer Care among Hospitalizaed Cancer Patients in Addis Abeba, Ethiopia
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Date
2022-06
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Addis Abeba University
Abstract
Background: Out of pocket (OOP) expenditure for cancer care exposes households to unanticipated expenditure. When the available health service is mainly dependent on out of pocket expenditure, then the household will face catastrophic health expenditure. Accordingly, this study aimed to estimate the incidence and intensity of catastrophic out of pocket expenditure for hospitalized cancer patients and to identify coping strategies and associated factors.
Method: Hospital based cross-sectional study was conducted in Addis Ababa city. Two public and three private hospitals were included in the study. Hospitals were selected based on their cancer case annual report and the sample size was proportionally allocated based on their patient load. The study participants were inpatient cancer cases who were on treatment follow up for the last one year preceding the interview date. The data was collected through face-to-face interview using structured questionnaire. All direct medical and non-medical and indirect expenditures were calculated. Indirect expenditure was calculated by using human capital model. The data were interred to Epi data3.1 and exported to STATA 16 for analysis. Multivariable logistic regression was applied to assess the relationship of CHE and the independent variables. For this study, household that spent ≥40% of nonfood expenditure for cancer care considered as catastrophic. Sensitivity analysis at different thresholds (20%, 25%, 30%) was done.
Result; The incidence and intensity (mean positive overshoot) of CHE at 40% threshold of households’ non food expenditure (capacity to pay) was 77.7% and 78.3%, respectively. CHE for cancer care was significantly associated with the type of facility, patient residence, cycle of chemotherapy, insurance enrolment and income quintiles. Saving and selling assets were identified as the main coping mechanisms.
Conclusion; The incidence and intensity of catastrophic out of pocket expenditure among cancer inpatients is very high. Improve quality and coverage of health insurance and decentralizing cancer care to regions at similar standard with Addis Ababa will save households from incurring CHE.
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Catastrophe, out of pocket expenditure, coping mechanisms, cancer