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The burden of household out-of-pocket health expenditures in Ethiopia: estimates from a nationally representative survey (2015-16).

  • Kiros, Mizan1
  • Dessie, Ermias2, 3
  • Jbaily, Abdulrahman4
  • Tolla, Mieraf Taddesse4
  • Johansson, Kjell Arne5
  • Norheim, Ole F4, 5
  • Memirie, Solomon Tessema5, 6
  • Verguet, Stéphane4
  • 1 Ethiopia Health Insurance Agency, Addis Ababa, Ethiopia. , (Ethiopia)
  • 2 Federal Ministry of Health, Addis Ababa, Ethiopia. , (Ethiopia)
  • 3 World Health Organization, Addis Ababa, Ethiopia. , (Ethiopia)
  • 4 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • 5 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. , (Norway)
  • 6 Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. , (Ethiopia)
Published Article
Health Policy and Planning
Oxford University Press
Publication Date
Oct 01, 2020
DOI: 10.1093/heapol/czaa044
PMID: 32772112


In Ethiopia, little is known about the extent of out-of-pocket health expenditures and the associated financial hardships at national and regional levels. We estimated the incidence of both catastrophic and impoverishing health expenditures using data from the 2015/16 Ethiopian household consumption and expenditure and welfare monitoring surveys. We computed incidence of catastrophic health expenditures (CHE) at 10% and 25% thresholds of total household consumption and 40% threshold of household capacity to pay, and impoverishing health expenditures (IHE) using Ethiopia's national poverty line (ETB 7184 per adult per year). Around 2.1% (SE: 0.2, P < 0.001) of households would face CHE with a 10% threshold of total consumption, and 0.9% (SE: 0.1, P < 0.001) of households would encounter IHE, annually in Ethiopia. CHE rates were high in the regions of Afar (5.8%, SE: 1.0, P < 0.001) and Benshangul-Gumuz (4.0%, SE: 0.8, P < 0.001). Oromia (n = 902 000), Amhara (n = 275 000) and Southern Nations Nationalities and Peoples (SNNP) (n = 268 000) regions would have the largest numbers of affected households, due to large population size. The IHE rates would also show similar patterns: high rates in Afar (5.0%, SE: 0.96, P < 0.001), Oromia (1.1%, SE: 0.22, P < 0.001) and Benshangul-Gumuz (0.9%, SE: 0.4, P = 0.02); a large number of households would be impoverished in Oromia (n = 356 000) and Amhara (n = 202 000) regions. In summary, a large number of households is facing financial hardship in Ethiopia, particularly in Afar, Benshangul-Gumuz, Oromia, Amhara and SNNP regions and this number would likely increase with greater health services utilization. We recommend regional-level analyses on services coverage to be conducted as some of the estimated low CHE/IHE regional values might be due to low services coverage. Periodic analyses on the financial hardship status of households could also be monitored to infer progress towards universal health coverage. © The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

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