An Analysis of household catastrophic health expenditure and food insecurity in Ghana
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Introduction
Catastrophic health expenditure (CHE) occurs when healthcare expenses exceed 10% or 25% of household income, or health expenses exceed 40% of non-food household expenditure. The incidence of catastrophic health expenditure in Sub-Saharan Africa (SSA) is between 12.9% and 20.4%. The relationship between CHE and food insecurity has been identified, but the literature on SSA and Ghana is sparse. Against this backdrop, concerted efforts are needed to identify the driving factors behind CHE and food insecurity. The high rate of OOP payments poses substantial risks to financial stability for many families, particularly those from lower socioeconomic backgrounds. Addressing these issues will ensure all Ghanaians can access quality health services without financial strain. This study analyzed the health spending of households and their relationship with food insecurity in the Eastern region of Ghana.
Objectives
We examined the prevalence of household CHE and the relationship between CHE and food insecurity in the Eastern region of Ghana.
Methods
The study objectives were to estimate the prevalence of CHE in the Eastern region of Ghana and its association with food insecurity. This study analyzed secondary data from the Ghana Annual Household Income and Expenditure Survey (AHIES), conducted quarterly by the Ghana Statistical Service (GSS) between 2021 and 2023, using a subset of data for the Eastern Region of Ghana. We retrieved data comprising 5990 households and 52 variables from the GSS website and exported it to R for statistical analysis. Relevant variables important to the study’s objectives were identified and aggregated at the household level. To determine our predictors, we utilised forward stepwise logistic regression. A variable was considered significant to the model if its inclusion decreased the model’s Akaike Information Criterion (AIC). Any variables that caused an increase of more than 2 points in the AIC were omitted from the model. After determining the final model, we applied it using the 25% and 40% household income thresholds.
Results
Among the households that had expended on health in the 2 weeks before data collection, 985 (16.4%) households experienced CHE at 10% relative to total household income, 929 (15.5%) at 25%, and 903 (15.1%) at 40%. The prevalence of households experiencing food insecurity among those who had utilised health services was 2,121 (61.9%). CHE was significantly associated with household food insecurity at all levels. Households experiencing CHE at 10% of household income were significantly more likely to experience food insecurity as well, OR (95% CI; p) = 1.76 (1.51, 2.07; p<0.001). Households in rural areas were also more likely, 1.47 (95% CI 1.25, 1.72; p<0.001) at 10%, 1.53 (95% CI 1.30, 1.80; p<0.001) at 25%, and 1.60 (95% CI 1.35, 1.89; p<0.001) at 40% of household income, to experience CHE, all statistically significant. Households with a member aged over 60 years or under 18 years old had higher odds of CHE, with an OR of [1.45 (95% CI 1.22, 1.71; p<0.001)] and [1.32 (95% CI 1.09, 1.61; p=0.004)] at a 10% threshold income, respectively.
Conclusion
There is a relatively high prevalence of Catastrophic Health Expenditure, which is significantly associated with food insecurity at the 10%, 25%, and 40% thresholds of household income in the Eastern region of Ghana. The educational level of the household head, the presence of a minor or older household member, and urbanicity are predictors of CHE. The national health insurance scheme is insufficient in providing financial risk protection, and the government must revisit its implementation.
