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Out-of-pocket expenditure for hypertension care: a population-based study in low-income urban Medellin, Colombia.

  • Londoño Agudelo, Esteban1, 2, 3, 4
  • García Fariñas, Anaí5
  • Pérez Ospina, Viviana6
  • Taborda Pérez, Cecilia7
  • Villacrés Landeta, Tatiana8
  • Battaglioli, Tullia1
  • Gómez Arias, Rubén3, 4
  • Van der Stuyft, Patrick2
  • 1 Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium. , (Belgium)
  • 2 Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University , Ghent, Belgium. , (Belgium)
  • 3 Facultad de Medicina, Universidad CES , Medellin, Colombia. , (Colombia)
  • 4 Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia , Medellín, Colombia. , (Colombia)
  • 5 Dirección de Investigación Clínica y Evaluación de Impacto, Instituto Finlay de Vacunas , La Habana, Cuba. , (Cuba)
  • 6 Dirección Ejecutiva, PSICOL -Psicología Ocupacional S.A.S , Medellín, Colombia. , (Colombia)
  • 7 UPSS Santa Cruz, Metrosalud E.S.E , Medellín, Colombia. , (Colombia)
  • 8 Facultad de Economía, Pontificia Universidad Católica del Ecuador , Quito, Ecuador. , (Ecuador)
Published Article
Global Health Action
Informa UK (Taylor & Francis)
Publication Date
Dec 31, 2020
DOI: 10.1080/16549716.2020.1806527
PMID: 32867605


Background Hypertension requires life-long medical care, which may cause economic burden and even lead to catastrophic health expenditure. Objective To estimate the extent of out-of-pocket expenditure for hypertension care at a population level and its impact on households' budgets in a low-income urban setting in Colombia. Methods We conducted a cross-sectional survey in Santa Cruz, a commune in the city of Medellin. In 410 randomly selected households with a hypertensive adult, we estimated annual basic household expenditure and hypertension-attributable out-of-pocket expenditure. For socioeconomic stratification, we categorised households according to basic expenditure quintiles. Catastrophic hypertension-attributable expenditure was defined as out-of-pocket expenditure above 10% of total household expenditure. Results The average annual basic household expenditure was US dollars at purchasing power parity (USD-PPP) $12,255.59. The average annual hypertension-attributable out-of-pocket expenditure was USD-PPP $147.75 (95% CI 120.93-174.52). It was incurred by 73.9% (95% CI 69.4%-78.1%) of patients, and consisted mainly of direct non-medical expenses (76.7%), predominantly for dietary requirements prescribed as non-pharmacological treatment and for transport to attend health care consultations. Medical out-of-pocket expenditure (23.3%) was for the most part incurred for pharmacological treatment. Hypertension-attributable out-of-pocket expenditure represented on average 1.6% (95% CI 1.3%-1.9%) of the total annual basic household expenditure. Eight households (2.0%; 95% CI 1.0%-3.8%) had catastrophic health expenditure; six of them belonged to the two lowest expenditure quintiles. Payments related to dietary requirements and transport to consultations were critical determinants of their catastrophic expenditure. Conclusions Out-of-pocket expenditure for hypertension care is moderate on average, but frequent, and mainly made up of direct non-medical expenses. Catastrophic health expenditure is uncommon and affects primarily households in the bottom socioeconomic quintiles. Financial protection should be strengthened by covering the costs of chronic diseases-related dietary requirements and transport to health services in the most deprived households. Abbreviations NCDs: Non-communicable diseases; LMICs: Low and middle-income countries; WHO: World Health Organization; HTN: hypertension; CVDs: Cardiovascular diseases; OOPE: out-of-pocket expenditure; USD-PPP: US dollars at purchasing power parity; CI: Confidence interval.

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