title: The economic burden of chronic disease care faced by households in Ukraine: a cross-sectional matching study of angina patients.
abstract: BACKGROUND
  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.
authors.affiliation: European Centre on Health of Societies in Transition, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. adrianna.murphy@lshtm.ac.uk
authors.forename: Adrianna
authors.initials: A
authors.lastname: Murphy
authors.forename: Ajay
authors.initials: A
authors.lastname: Mahal
authors.forename: Erica
authors.initials: E
authors.lastname: Richardson
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060050:Angina, Stable / Q000191:economics* / Q000628:therapy; D002908:Chronic Disease; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014455:Ukraine; D055815:Young Adult