Catastrophic household expenditure on health in Nepal: a cross-sectional survey.
OBJECTIVE
To determine the incidence of - and illnesses commonly associated with - catastrophic household expenditure on health in Nepal.


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.


RESULTS
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, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease.


CONCLUSIONS
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.
Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan .
Eiko
E
Saito
Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan .
Stuart
S
Gilmour
Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan .
Md Mizanur
MM
Rahman
Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH, Kathmandu, Nepal .
Ghan Shyam
GS
Gautam
Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal .
Pradeep Krishna
PK
Shrestha
Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan .
Kenji
K
Shibuya
D002388:Catastrophic Illness / Q000191:economics*; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009390:Nepal; D012307:Risk Factors