Introduction: Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, and
their prevalence in lower- and middle-income countries (LMIC) is on the rise. The burden of chronic health
expenditure born by patient households in these countries may be very high, particularly where out-of-pocket
payments for health care are common. One such country where out-of-pocket payments are especially high is
Ukraine. The financial impact of NCDs on households in this country has not been researched.
Methods: We set out to explore the burden of NCD care in Ukraine with a study of angina patients. Using data
from the Ukraine World Health Survey of 2003 we employed the novel Coarsened Exact Matching approach to
estimate the difference in out-of-pocket payment (OPP) for health care between households with a stable angina
pectoris (a chronic form of IHD) patient and those without. The likelihood of engaging in catastrophic spending
and using various distress financing mechanisms (e.g. sale of assets, borrowing) among angina households
compared with non-angina households was also explored.
Results: Among angina patient households (n = 203), OPP occupied an average of 32% of household effective
income. After matching, angina households experienced significantly higher monthly per capita OPP for health care
(B = $2.84) and medicines (B = $2.94), but were not at significantly higher odds of engaging in catastrophic
spending. Odds of engaging in ‘sale of assets’ (OR = 2.71) and ‘borrowing’ (OR = 1.68) to finance OPP were
significantly higher among angina households.
Conclusions: The cost of chronic care in Ukraine places a burden on individual patient households. Households of
angina patients are more likely to engage in distress financing to cover the cost of treatment, and a high
proportion of patients do not acquire prescribed medicines because they cannot afford them. This warrants further
research on the burden of NCD care in other LMIC, especially where OPP for health care is common. Health policies
aimed at reducing OPP for health care, and especially medicines, would lessen the high health and financial burden
of chronic care. Further research is also needed on the long-term impact of borrowing or sale of assets to finance
OPP on patient households.