Objective
To determine the incidence of catastrophic household expenditure on health in Nepal and the illnesses commonly associated with such expenditure.
Methods
We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household’s total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index.
Findings
Overall, 284 of the 1997 households studied in Kathmandu – i.e. 13.8%, after adjustment by sampling weight – reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, such expenditure was found to be associated with injuries – particularly those resulting from road traffic accidents – and in the households that belonged to the poorest quintile – with at least one episode of diabetes, asthma or heart disease.
Conclusion
In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.