Examining catastrophic health expenditures at variable thresholds using household consumption expenditure diaries
Objective Using uniform thresholds and a set of variable threshold levels, this study examined the incidence of catastrophe amongst households of different socio‐economic status (SES) quintiles.
Methods A household diary was used to collect illness and household consumption expenditure data from 1128 households over 1 month. Catastrophic health expenditure was examined based on uniform threshold levels of non‐food expenditure and a novel set of variable thresholds in which the levels for various SES groups were weighted by the ratio of household expenditure on food.
Results A total of 167 households (14.8%) experienced catastrophe at a non‐food expenditure threshold of 40%, with 22.6% and 7.6% of the poorest and richest household quintiles experiencing catastrophe. For the first set of variable scenarios, the thresholds for the poorest and richest household quintiles were 5% and 29.6% and levels of catastrophe were 44.7% and 12.0%, respectively, while the overall level was 36.5%. In the second scenario, the thresholds were 6.8% and 40%, and the levels of catastrophe were 42.5% and 7.6%, respectively, while the overall level was 32.0%.
Conclusions High levels of catastrophic expenditure exist in Nigeria. Use of variable thresholds to measure catastrophe led to higher overall and disaggregated levels of catastrophe. Such a measure is argued to be more appropriate for the examination of catastrophe.
Document Type: Research Article
Affiliations: 1: Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria 2: Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria 3: London School of Hygiene and Tropical Medicine, London, UK 4: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
Publication date: October 1, 2011