Assessing Household Out-of-Pocket Expenditures for Non-communicable Diseases in a 4th Class Municipality: A Cross-sectional Study

Abstract

Background and Objective. Non-communicable diseases (NCDs) are medical conditions that are associated with long durations, slow progress, and lifetime medications. This study aimed to assess the household out-of-pocket (OOP) expenditures on NCDs in a 4th class municipality.

Methods. This cross-sectional study was conducted to determine the characteristics of the households and household heads, healthcare needs, expenditures on medicines, health, and household, and alternative coping strategies to avail healthcare needs.

Results. This study surveyed 200 households from all ten barangays of Ternate, Cavite. Top NCDs recorded include hypertension, diabetes, heart diseases, and asthma, while top NCDs medicines recorded were Losartan, Amlodipine, Metformin, and Glimepiride. Blood tests were the most needed medical laboratory service, while X-ray was the most needed diagnostic imaging service. Although more than half of the households have a member with only one NCD— the most prevalent being hypertensive disease, diabetes mellitus and other metabolic diseases—it is also common to have household members taking medicines for two to three NCDs.

To cope with healthcare expenses, households often resorted to seeking alternative or cheaper treatments (61.0%), borrowing money (39.5%), or relying on existing funds/savings (29.0%). The median proportion of expenditures on medicines for NCDs over the total health expenditures is 59.41%. Meanwhile, the median proportion of all medicine expenditures over the total health expenditures is at 77.57%. 74.00% of households incurred catastrophic health expenditures (CHE) using the 10% threshold, while only 30.50% incurred CHE using the 25% threshold. Finally, the univariable analysis found that households with one NCD member had lower odds of CHE (OR=0.316, p=0.004 at 10%, OR=0.39, p=0.003 at 25%), while those with two NCD members had higher odds at 10% (OR=2.365, p=0.034) and those with three members had nearly six times higher odds at 25% (OR=5.88, p=0.012).

Conclusion. This study highlights the need to address issues with lack of access and availability of essential medicines for NCDs especially in the primary health care setting. This study provides evidence on the minimal financial risk protection provided for medicines with data suggesting that it is the primary cause of CHEs for NCDs. Households covered by the Primary Care Benefit Packages were excluded from the study, thus, the estimates derived from the sample may be an overestimate of the true prevalence of CHE in the municipality. Therefore, there is a need to have mechanisms in place to expand insurance coverage and increase government programs catering to certain population groups to reduce the financial burden of medicines for NCDs.