Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia

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dc.contributor.authorHailemichael, Yohannes
dc.contributor.authorHailemariam, Damen
dc.contributor.authorTirfessa, Kebede
dc.contributor.authorDocrat, Sumaiyah
dc.contributor.authorAlem, Atalay
dc.contributor.authorMedhin, Girmay
dc.contributor.authorLund, Crick
dc.contributor.authorChisholm, Dan
dc.contributor.authorFekadu, Abebaw
dc.contributor.authorHanlon, Charlotte
dc.date.accessioned2019-07-02T11:02:52Z
dc.date.available2019-07-02T11:02:52Z
dc.date.issued2019-06-01
dc.date.updated2019-06-02T06:37:51Z
dc.description.abstractAbstract Background There are limited data on healthcare spending by households containing a person with severe mental disorder (SMD) in low- and middle-income countries (LMIC). This study aimed to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) payments and coping strategies implemented by households with and without a person with SMD in a rural district of Ethiopia. Methods A comparative cross-sectional community household survey was carried out from January to November 2015 as part of the Emerald programme (emerging mental health systems in low- and middle-income countries). A sample of 290 households including a person with SMD and 289 comparison households without a person with SMD participated in the study. An adapted and abbreviated version of the World Health Organization SAGE (Study on global Ageing and adult health) survey instrument was used. Households were considered to have incurred catastrophic health expenditure if their annual OOP health expenditures exceeded 40% of their annual non-food expenditure. Multiple logistic regression was used to explore factors associated with catastrophic expenditure and types of coping strategies employed. Results The incidence of catastrophic OOP payments in the preceding 12 months was 32.2% for households of a person with SMD and 18.2% for comparison households (p = 0.006). In households containing a person with SMD, there was a significant increase in the odds of hardship financial coping strategies (p < 0.001): reducing medical visits, cutting down food consumption, and withdrawing children from school. Households of a person with SMD were also less satisfied with their financial status and perceived their household income to be insufficient to meet their livelihood needs (p < 0.001). Conclusions Catastrophic OOP health expenditures in households of a person with SMD are high and associated with hardship financial coping strategies which may lead to poorer health outcomes, entrenchment of poverty and intergenerational disadvantage. Policy interventions aimed at financial risk pooling mechanisms are crucial to reduce the intensity and impact of OOP payments among vulnerable households living with SMD and support the goal of universal health coverage.
dc.identifier.apacitationHailemichael, Y., Hailemariam, D., Tirfessa, K., Docrat, S., Alem, A., Medhin, G., ... Hanlon, C. (2019). Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia. <i>International Journal of Mental Health Systems</i>, http://hdl.handle.net/11427/30278en_ZA
dc.identifier.chicagocitationHailemichael, Yohannes, Damen Hailemariam, Kebede Tirfessa, Sumaiyah Docrat, Atalay Alem, Girmay Medhin, Crick Lund, Dan Chisholm, Abebaw Fekadu, and Charlotte Hanlon "Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia." <i>International Journal of Mental Health Systems</i> (2019) http://hdl.handle.net/11427/30278en_ZA
dc.identifier.citationHailemichael, Y., Hailemariam, D., Tirfessa, K., Docrat, S., Alem, A., Medhin, G., ... & Hanlon, C. (2019). Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia. International journal of mental health systems. 13(1): 39.
dc.identifier.ris TY - AU - Hailemichael, Yohannes AU - Hailemariam, Damen AU - Tirfessa, Kebede AU - Docrat, Sumaiyah AU - Alem, Atalay AU - Medhin, Girmay AU - Lund, Crick AU - Chisholm, Dan AU - Fekadu, Abebaw AU - Hanlon, Charlotte AB - Abstract Background There are limited data on healthcare spending by households containing a person with severe mental disorder (SMD) in low- and middle-income countries (LMIC). This study aimed to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) payments and coping strategies implemented by households with and without a person with SMD in a rural district of Ethiopia. Methods A comparative cross-sectional community household survey was carried out from January to November 2015 as part of the Emerald programme (emerging mental health systems in low- and middle-income countries). A sample of 290 households including a person with SMD and 289 comparison households without a person with SMD participated in the study. An adapted and abbreviated version of the World Health Organization SAGE (Study on global Ageing and adult health) survey instrument was used. Households were considered to have incurred catastrophic health expenditure if their annual OOP health expenditures exceeded 40% of their annual non-food expenditure. Multiple logistic regression was used to explore factors associated with catastrophic expenditure and types of coping strategies employed. Results The incidence of catastrophic OOP payments in the preceding 12 months was 32.2% for households of a person with SMD and 18.2% for comparison households (p = 0.006). In households containing a person with SMD, there was a significant increase in the odds of hardship financial coping strategies (p < 0.001): reducing medical visits, cutting down food consumption, and withdrawing children from school. Households of a person with SMD were also less satisfied with their financial status and perceived their household income to be insufficient to meet their livelihood needs (p < 0.001). Conclusions Catastrophic OOP health expenditures in households of a person with SMD are high and associated with hardship financial coping strategies which may lead to poorer health outcomes, entrenchment of poverty and intergenerational disadvantage. Policy interventions aimed at financial risk pooling mechanisms are crucial to reduce the intensity and impact of OOP payments among vulnerable households living with SMD and support the goal of universal health coverage. DA - 2019-06-01 DB - OpenUCT DP - University of Cape Town J1 - International Journal of Mental Health Systems KW - Catastrophic health expenditure KW - Severe mental disorders KW - Low- and middle-income KW - Ethiopia KW - Universal health coverage LK - https://open.uct.ac.za PY - 2019 T1 - Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia TI - Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia UR - http://hdl.handle.net/11427/30278 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s13033-019-0294-7
dc.identifier.urihttp://hdl.handle.net/11427/30278
dc.identifier.vancouvercitationHailemichael Y, Hailemariam D, Tirfessa K, Docrat S, Alem A, Medhin G, et al. Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia. International Journal of Mental Health Systems. 2019; http://hdl.handle.net/11427/30278.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.sourceInternational Journal of Mental Health Systems
dc.source.urihttps://ijmhs.biomedcentral.com/
dc.subjectCatastrophic health expenditure
dc.subjectSevere mental disorders
dc.subjectLow- and middle-income
dc.subjectEthiopia
dc.subjectUniversal health coverage
dc.titleCatastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia
dc.typeJournal Article
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