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. 2018 Nov 15;8(11):e022002.
doi: 10.1136/bmjopen-2018-022002.

Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study

Prajjwal Pyakurel  1 , Jaya Prasad Tripathy  2   3 , Myo Minn Oo  4 , Bijay Acharya  5 , Ujjwal Pyakurel  6 , Suman Bahadur Singh  1 , Laxmi Subedi  1 , Kamlesh Prasad Yadav  1 , Mukesh Poudel  1 , Dipesh Raj Pandey  7 , Shyam Sundar Budhathoki  1 , Guna Raj Lohani  8 , Nilambar Jha  1
Affiliations

Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study

Prajjwal Pyakurel et al. BMJ Open. .

Abstract

Objectives: The study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal.

Methods: We conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health.

Results: Of 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71-282) and US$36 (19-61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector.

Conclusion: Industrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.

Keywords: health economics; health policy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow of participants screened for hospitalisation in the last year or outpatient visit in the last 30 days among workers in a large industry in Nepal, 2017.
Figure 2
Figure 2
Percentage share of components of healthcare expenditure both due to hospitalisation and outpatient care in a large industry in Nepal, 2017.
See this image and copyright information in PMC

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