Catastrophic and impoverishing impacts of health expenditures: a focus on non-communicable diseases in Pokhara Metropolitan City, Nepal.

Background: Ensuring equitable access to Universal Health Coverage (UHC) is crucial, particularly in low-resource settings like Nepal, where high out-of-pocket expenditure (OOPE) poses a significant barrier to the utilization of healthcare services. This study examined the catastrophic and impoverishing impact of household-level healthcare expenditures, focusing on whether households with NCDs have a higher likelihood of incurring CHE and experiencing impoverishment.

Methods: We conducted this study in Pokhara Metropolitan City, Nepal, involving 1,276 households. Catastrophic Health Expenditure (CHE) was defined when OOPE was 10% or more of the household's total expenditure, while impoverishment was measured using the poverty headcount ratio, poverty gap, and squared poverty gap. We used a poverty line of NPR 7,674 (approximately USD 230 in Purchasing Power Parity) per capita per month, as set by the National Statistics Office for the Gandaki urban area in 2024. Total monthly household consumption was the sum of food and non-food expenditures, including healthcare expenditures. Health expenditure was calculated based on self-reported data validated by pertinent documents. Household weight was used in the data analysis.

Results: Out of 1276 households, 853 (66.8%) reported illness in the past month, and 125 households suffered from CHE. This corresponds to 9.8% of all sampled and 14.6% of households that experienced illness. Out of those 125 households, 82 faced CHE due to NCDs, representing 6.4% of all sampled and 9.6% of households experiencing illness. Most health expenditures were primarily due to medication (60%) and curative care (17.3%) in NCD conditions. The poverty rate increased by 1.17%points, from 9.4% to 10.6%, over the past month due to healthcare costs, leading to a 12.3% increase in people living in poverty, with 1.02%points attributed to NCDs. The poverty gap rose from 1.5% to 1.9%, and the squared poverty gap increased from 0.003 to 0.005. Households with more than two members affected by NCDs had 3 times higher odds of experiencing CHE (AOR 3.02, 95% CI 2.59-3.51). Those with a household member/s suffering from heart disease had twice the odds of facing CHE (AOR 2.41, 95% CI 2.22-2.62). Households with diabetic members had 1.13 times higher odds of experiencing CHE (AOR = 1.13, 95% CI: 1.05-1.21). Households in the lowest quintile had twice the odds of incurring CHE than those in the highest quintile (AOR 1.93, 95% CI 1.75-2.15).

Conclusion: NCDs and their associated costs are significant contributors to CHE and impoverishment. As Nepal moves towards UHC, policymakers need to accord the highest priority to enhancing financial protection mechanisms by subsidizing healthcare costs, particularly for medicines and curative care related to NCDs. Furthermore, addressing economic inequalities through targeted support for low-income and marginalized households will mitigate CHE and prevent impoverishment.