Determinants of catastrophic healthcare expenditure in Uganda

Abstract

Catastrophic Healthcare Expenditure (CHE) has led to impoverishment and deprivation of consumption of other basic needs within households. It is on this background that this study sought to establish the determinants of CHE. The study utilized UNHS (2016/17) data and the modified WHO approach to estimate CHE. If the ratio of a household’s OOPPs for healthcare to its non-subsistence expenditure was ≥ 40% then it incurred CHE and if it was < 40% it did not incur CHE. The logistic model had the lowest AIC value so it was adopted over the probit and complementary log-log models to establish the determinants of CHE in households in Uganda. The study found the incidence of CHE to be 12.9%. Households in urban areas are less likely to incur CHE (OR=0.665) compared to households in rural areas. Households headed by persons who had attained; primary, secondary, and tertiary education were less likely to incur CHE (OR=0.782, OR=0.627, OR=0.493 respectively) compared to households headed by persons with no formal education. Households with at least a member covered under health insurance are less likely to incur in CHE (OR=0.502) compared to households with no member under health insurance. Households that mainly used charcoal and firewood as a source of fuel for cooking are more likely to incur CHE (OR=2.527 and OR=3.317 respectively) compared to households that mainly used non solid sources of fuel for cooking. Results indicate that households; dwelling in urban areas, headed by educated persons, headed by employed persons, those with persons covered under health insurance schemes and larger households are less likely to incur CHE. Households that mainly use charcoal or firewood as a source of fuel for cooking are more likely to incur CHE. The study recommends the need for a national health insurance scheme, this would reduce the likelihood of incurring CHE. More emphasis should be put on dealing with disparities between areas and across various age groups to improve the literacy rates, income generating activities and ability to maintain good family health over time. Subsidization of prices or removal of taxes on electricity, liquefied propane gas and solar equipment in order to encourage their use and a transition away from charcoal and firewood for cooking.