The effect of wealth status on care seeking and health expenditures in Afghanistan

Bibliographic Data

ID11490900
AuthorsLaura C Steinhardt (0000-0003-0540-9940, Johns Hopkins University, corresponding author), Hugh Waters (Johns Hopkins University), K D Rao (Johns Hopkins University), Ahmad Jan Naeem (0000-0003-4305-5717, Ministry of Public Health), Preben Hansen (0000-0002-5150-9101, Johns Hopkins University), David H Peters (0000-0001-8377-3444, Johns Hopkins University)
Year2008
Volume24
Issue1
Pages1-17
Publication date2008-11-12
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czn043
PMID19060032
OpenAlexW2142495043
LanguageEN
Citations received23
References cited27

This paper analyses the effect of wealth status on care-seeking patterns and health expenditures in Afghanistan, based on a national household survey conducted within public health facility catchment areas. We found high rates of reported care-seeking, with more than 90% of those ill seeking care. Sick individuals from all wealth quintiles had high rates of care-seeking, although those in the wealthiest quintile were more likely to seek care than those from the poorest (odds ratio 2.2; 95% CI 1.6, 3.0). The nearest clinic providing the government's Basic Package of Health Services (BPHS) was the most commonly sought first provider (53% overall), especially for relatively poor households (62% in poorest vs. 42% in least poor quintile, P < 0.0001). Sick individuals from wealthier quintiles used hospitals and for-profit private providers more than those in poorer quintiles. Multivariate analysis showed that wealth quintile was the strongest predictor of seeking care, and of going first to private providers. More than 90% of those seeking care paid money out-of-pocket. Mean (median) expenditures among those paying for care in the previous month were 873 Afghanis (200 Afghanis), equivalent to US$17.5 (US$4). Expenditures were lowest at BPHS clinics and highest at private providers. Financing care through borrowing money or selling assets/land ('any distress' financing) was reported in nearly 30% of cases and was almost twice as high among households in the poorest versus the least poor quintile (P < 0.0001). Financing care through selling assets/land ('severe distress' financing) was less common (10% overall) and did not differ by wealth status. These findings indicate that BPHS facilities are being used by the poor who live close to them, but further research is needed to assess utilization among populations in more remote areas. The high out-of-pocket health expenditures, particularly for private sector services, highlight the need to develop financial protection mechanisms in Afghanistan.

Business · Economic growth · Economics · Government (linguistics) · Health care · Logistic regression · Multivariate analysis · Odds · Poverty · Public health · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing