Estimating the level and determinants of catastrophic expenditure related to hypertension management in the Greater Accra Region of Ghana

Abstract

Background: Since the establishment of national health insurance in Ghana, the government’s health policy has focused on reducing out-of-pocket expenditure (OOP) to ensure that people do not become poorer while accessing healthcare services. However, studies show that OOP expenditure remains high, and a substantial portion of the population experiences catastrophic health expenditure (CHE). Objective(s): We estimated the level and determinants of catastrophic health expenditures for hypertension management among adults in the Greater Accra Region of Ghana. Methods: We conducted a cross-sectional CHE survey at two randomly selected district primary health facilities in the Greater Accra Region. Data collection took place between December 2023 and February 2024. A questionnaire was used to collect data on direct and indirect medical expenditures related to hypertension care from 382 participants. CHE was defined at thresholds of 10% and 40% of the household’s capacity for direct and indirect medical expenditures, respectively. Multivariate logistic regression was used to assess the determinants of CHE. Results: A total of 382 patients were included in the analysis; the majority were females (76%), and Christians (95%). Based on the 10% and 40% thresholds of household income capacity to pay, 65% and 58% of the total sample experienced CHE, respectively. The regression model revealed that being widowed (OR = 0.32, 95% CI: 0.09–1.10, p = 0.07), unemployed (OR = 0.26, 95% CI: 0.08–0.09, p = 0.03), and having a large household size (OR = 1.32, 95% CI: 0.95–1.84, p = 0.09) correlate with CHE for hypertension management and care. Conclusion: The study demonstrates that hypertension care imposes a considerable financial burden on households.