title: Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey.
abstract: BACKGROUND
  Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures.
  
  
  METHODS
  We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects.
  
  
  RESULTS
  Increasing age, female gender, obesity and functional disability increased the adults' out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head's occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer's visits were significantly associated with high catastrophic health expenditures.
  
  
  CONCLUSIONS
  We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare programs and strengthening the social security mechanisms could reduce the financial burden in United Republic of Tanzania.
authors.affiliation: Department of Public Health, Section for Health Services Research and Health Promotion, Aarhus University, Aarhus C 8000, Denmark. ebam@soci.au.dk.
authors.forename: Ethel Mary
authors.initials: EM
authors.lastname: Brinda
authors.forename: Antonio Rodríguez
authors.initials: AR
authors.lastname: Andrés
authors.forename: Rodriguez Antonio
authors.initials: RA
authors.lastname: Andrés
authors.forename: Ulrika
authors.initials: U
authors.lastname: Enemark
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002388:Catastrophic Illness / Q000191:economics*; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000191:economics*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008519:Medicine, Traditional / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D012044:Regression Analysis; D012737:Sex Factors; D012959:Socioeconomic Factors; D013636:Tanzania; D055815:Young Adult