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Cited by 57Healthcare Systems and ReformsEconomic and Financial Impacts of CancerPoverty, Education, and Child Welfare

Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey

Open access
Ghimire, Mamata, Ayer, Rakesh, Kondo, Masahide·2018·International Journal for Equity in Health
DOI 10.1186/s12939-018-0736-xPMC PMC5813388
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Abstract

BACKGROUND: Nepal has committed to the global community to achieve universal health coverage by 2030. Nevertheless, Nepal still has a high proportion of out-of-pocket health payment and a limited risk-pooling mechanism. Out-of-pocket payment for the healthcare services could result in catastrophic health expenditure (CHE). Evidence is required to effectively channel the efforts to lower those expenses in order to achieve universal health coverage. However, little is known about CHE and its determinants in a broad national context in Nepal. Therefore, this study was conducted to explore the cumulative incidence, distribution, and determinants of CHE in Nepal. METHODS: Data were obtained from the nationally representative survey, the Nepal Living Standards Survey-third undertaken in 2010/11. Information from 5988 households was used for the analyses. Households were classified as having CHE when their out-of-pocket health payment was greater than or equal to 40% of their capacity to pay. Remaining households were classified as not having CHE. Logistic regression analyses were used to identify determinants of CHE. RESULTS: Based on household-weighted sample, the cumulative incidence of CHE was 10.3% per month in Nepal. This incidence was concentrated in the far-western region and households in the poorer expenditure quartiles. Multivariable logistic regression revealed that households were more likely to face CHE if they; consisted of chronically ill member(s), have a higher burden of acute illness and injuries, have elderly (≥60 years) member(s), belonged to the poor expenditure quartile, and were located in the far-western region. In contrast, households were less likely to incur CHE when their household head was educated. Having children (≤5 years) in households did not significantly affect catastrophic health expenditure. CONCLUSIONS: This study identified a high cumulative incidence of CHE. CHE was disproportionately concentrated in the poor households and households located in the far-western region. Policy-makers should focus on prioritizing households vulnerable to CHE. Interventions to reduce economic burden of out-of-pocket healthcare payment are imperative to lower incidences of CHE among those households. Improving literacy rate might also be useful in order to lower CHE and facilitate universal health coverage.

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  • The study's catastrophic health expenditure definitions and data collection methods have been externally validated by several studies conducted in similar research contexts.

    “Our CHE definitions and data collection methods have been externally validated by several studies conducted in similar research contexts [22–24].”

    From Community and facility-level barriers to achieving UHC in Kono District, Sierra Leone and Maryland County, Liberia (2023) · cites this paper as [23]

    The Methods sections (Measurement of CHE and Data source; pages not specified) show that this Nepal study applied a CHE definition and analysed household survey data, providing a precedent in a similar context. They do not report an external validation of the citing authors’ definitions or data collection methods. (LLM, conf=0.84)

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Research works printed but not linked: 6

  1. World Health Organization. Tracking universal health coverage: first global monitoring report. Geneva: World Health Organization; 2015.
  2. World Health Organization. WHO global health expenditure atlas. Geneva: World Health Organization; 2014.
  3. Government of Nepal, Department of Health Services. National health insurance policy. Kathmandu: Government of Nepal; 2013.
  4. Ministry of Health and Population. Nepal health sector strategy 2015–2020. Kathmandu: Government of Nepal; 2015.
  5. Social Health Security Development Committee. Annual report 2072/73. Kathmandu, Nepal: Government of Nepal; 2016.
  6. Central Bureau of Statistics. Nepal living standards survey 2010/11: statistical report. Kathmandu: Government of Nepal; 2011.

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Authors
Ghimire, M., Ayer, R., & Kondo, M.
Affiliations
  • University of Tsukuba (JP)
  • The University of Tokyo (JP)
Corresponding author
Ghimire, Mamata
ORCID
Venue
International Journal for Equity in Health
Publisher
Springer Science and Business Media LLC
Published
2018-02-14
Volume
17
Issue
1
Pages
23-23
ISSN
1475-9276 (ISSN-L)
DOI
10.1186/s12939-018-0736-x
PMC
PMC5813388
OpenAlex
W2790454730
Cited by
57
References
36
Citations by year
2026: 4 · 2025: 8 · 2024: 3 · 2023: 7 · 2022: 8 · 2021: 14 · 2020: 7 · 2019: 5 · 2018: 1
FWCI
8.92
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • International Journal for Equity in Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
  • Social Sciences › Development › Poverty, Education, and Child Welfare
Keywords
catastrophic health expenditure, universal health coverage, determinants of catastrophic health expenditure, household poverty, chronic disease, elderly households, household education, Nepal
MeSH terms
Adolescent, Adult, Aged, Catastrophic Illness, Child, Child, Preschool, Cross-Sectional Studies, Health Expenditures, Female, Humans, Male, Middle Aged, Nepal, Surveys and Questionnaires, Socioeconomic Factors, Incidence, Young Adult

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