Comparison of Catastrophic Health Expenditure among Health-Insured and Noninsured Diabetic Patients in Kaduna State, North West Nigeria.

Abstract

Background: Diabetes imposes significant economic burdens on individuals and households through higher out-of-pocket payment. Access to affordable care is critical to reducing mortality and associated suffering.

Aim: To assess and compare catastrophic health expenditure (CHE) and factors associated with CHE among health-insured and noninsured diabetic patients in Kaduna State, Nigeria.

Materials and methods: A comparative cross-sectional study was conducted using a multistage sampling technique to select 500 respondents. Using an interviewer-administered questionnaire, information was collected on sociodemographic characteristics, income, cost of care, and CHE.

Results: The mean age of the respondents was 50.0 ± 1.3 years and 53.7 ± 14.6 years for the health-insured and non-insured groups, respectively. About 42% and 68% of the health-insured and insured patients incurred CHE, respectively (P = 0.001). The intensity of CHE was 18.3% and 26.2% for the health-insured and noninsured diabetic patients, respectively (P = 0.43). Religion (AOR: 1.98; CI: 4.21-6.6; P = 0.048), occupation (AOR: 0.13; CI: 0.042-0.421; P = 0.001), and duration of diabetes (AOR: 2.1; CI: 1.021-8.223; P = 0.045) were found to be associated with CHE.

Conclusion: The study found a significant difference in the incidence of CHE between the two groups, although the difference in intensity of CHE was not significant. It is recommended that the Federal and State Governments ensure health insurance coverage and other social safety nets for nonformal sector diabetic patients to protect them from CHE.