Tadiwos Yamlak Bereket, Kassahun Meseret Molla, Mebratie Anagaw Derseh
Department of Health Systems Management and Health Policy, School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
Health Econ Rev. 2025 Mar 1;15(1):15. doi: 10.1186/s13561-025-00602-1.
Out-of-pocket payment remains one of the ways to finance health care in Ethiopia accounting 31%. These out-of-pocket health expense leads citizens' face catastrophic and impoverishing expenditure. The most recent survey-based study of catastrophic and impoverishing health expenditure was done from the 2015/16 consumption and expenditure survey with finding of 2.1% and 1% respectively.
To assess catastrophic and impoverishing out-of-pocket health expenditure and the determinant factors of catastrophic health expenditure in Ethiopia, 2023 from the 2018/19 socioeconomic survey.
A secondary data from Ethiopian socioeconomic survey 2018/19 conducted by Ethiopia's Central Statistical Agency and World Bank was used to assess the catastrophic and impoverishing health expenditure at the national and subnational level by the Wagstaff and Van Doorslaer and Xu et al. methodology. Then binary logistic regression was computed by the STATA (ver.12) software to assess the determinant factors of catastrophic health expenditure.
From 6770 households 1.49% and 0.89% of them in Ethiopia faced catastrophic and impoverishing health expenditure respectively at 10% threshold level and households having a member with more facility visit had increased likelihood of facing catastrophic health expenditure (AOR = 2.45, 95%CI; 1.6-3.8) and also having member being hospitalized in the household had increased odds of facing catastrophic health expenditure (Adjusted odds ratio, AOR = 1.9, 95% confidence interval, CI; 1.19- 3.16). On the contrary, there is a decreased likelihood of facing catastrophic health expenditure among those who were insured for health (AOR = 0.58, 95%CI; 0.35- 0.97) and was in the richest consumption quintile group (AOR = 0.6, 95%CI; 0.47- 0.65).
The finding indicates that there are still notable households facing catastrophic and impoverishing out-of-pocket health expenditure in Ethiopia especially in the lower consumption quintiles indicating inequity. In addition it is found that those with health insurance coverage, lower hospitalization and health service utilization had lower chance of facing catastrophic health payment. So it is suggested that activities that reduce hospitalization rate, increase insurance coverage and addressing the poor must be in place so that the catastrophic health cost incurred can be lowered at national level.
自付费用仍是埃塞俄比亚医疗保健筹资的方式之一，占比31%。这些自付医疗费用导致民众面临灾难性和致贫性支出。最近一项基于调查的灾难性和致贫性医疗支出研究是根据2015/16年消费和支出调查进行的，结果分别为2.1%和1%。
根据2018/19年社会经济调查评估2023年埃塞俄比亚灾难性和致贫性自付医疗支出以及灾难性医疗支出的决定因素。
使用埃塞俄比亚中央统计局和世界银行进行的2018/19年埃塞俄比亚社会经济调查的二手数据，采用瓦格斯塔夫、范多尔斯拉尔和徐等人的方法，在国家和次国家层面评估灾难性和致贫性医疗支出。然后使用STATA（版本12）软件进行二元逻辑回归，以评估灾难性医疗支出的决定因素。
在埃塞俄比亚的6770户家庭中，分别有1.49%和0.89%的家庭在10%阈值水平上面临灾难性和致贫性医疗支出，家中有成员就诊次数较多的家庭面临灾难性医疗支出的可能性增加（调整后比值比，AOR = 2.45，95%置信区间；1.6 - 3.8），家中有成员住院的家庭面临灾难性医疗支出的几率也增加（调整后比值比，AOR = 1.9，95%置信区间，CI；1.19 - 3.16）。相反，有健康保险的人群（AOR = 0.58，95%置信区间；0.35 - 0.97）以及处于最富有消费五分位数组的人群（AOR = 0.6，95%置信区间；0.47 - 0.65）面临灾难性医疗支出的可能性降低。
研究结果表明，在埃塞俄比亚，尤其是在较低消费五分位数组中，仍有相当数量的家庭面临灾难性和致贫性自付医疗支出，这表明存在不公平现象。此外，研究发现，拥有医疗保险、住院率较低和医疗服务利用率较低的人群面临灾难性医疗支付的机会较低。因此，建议开展降低住院率、提高保险覆盖率和帮扶贫困人口的活动，以便在国家层面降低灾难性医疗费用。
