Determinants of catastrophic health expenditure attributable to non-communicable diseases and impoverishment in Pakistan

Background Pakistan has a disproportionately high burden of non-communicable diseases (NCDs), leading to an increase in healthcare utilization and associated out-of-pocket health expenditure, adversely affecting the well-being of the household. This study aims to identify the determinants of catastrophic health expenditure (CHE) on NCDs and quantify the impoverishment effects of OOP expenditure attributable to NCDs. Methods The study used Household Integrated Economic Survey - 2018/2019 and the National Health Accounts Data 2017. The welfare impact of out-of-pocket health spending associated with NCDs was assessed using specific measures: a) incidence and intensity of catastrophic health expenditure and b) the impoverishing effect. A generalized linear model with a logit link function was used to study the determinants of CHE at different thresholds. Results The poverty headcount was 20.5% without accounting for OOP expenditure for NCDs; with adjustment, it increased to 27%, causing 13 million (from 42.4 million to 55.6) more people to fall into poverty. Households experiencing CHE fell from 60% to 3.5% as the threshold increased from 10% to 40%, implying fewer households encounter CHE at higher thresholds. Larger families, male-headed, families with children and older members, having more members with NCDs, and using private healthcare were more likely to incur CHE. Conclusions CHE has a high propensity to push households into poverty. Pakistan’s National Health Vision 2016-2025 recognizing the provision of Universal Health Coverage and poverty alleviation as the top health and social priorities needs to be implemented to achieve Sustainable Development Goal targets of UHC and financial risk protection. Key messages Household’s out-of-pocket spending associated with non-communicable disease was USD19 per month. Female headed families had a lower likelihood of incurring catastrophic health expenditure on NCDs than the male. Only a fewer households encountered catastrophic health expenditure at higher thresholds. Rural households had a higher impoverishing effect of out-of-pocket expenditure associated with NCDs compared to the urban.