Out-of-pocket and catastrophic expenditure among Schizophrenia patients and CBHI enrollment at St. Amanuel Mental Specialized Hospital (ST.AMSH): a hospital based comparative study

Background In Ethiopia, limited mental health service coverage and financial protection expose households to severe economic consequences from psychiatric disorders. One of the most common and increasing disorders being Schizophrenia, schizophrenic patients and caregivers face treatment costs, income loss, unemployment, and social stigma, highlighting the need to evaluate out-of-pocket (OOP) expenditures and the protective role of Community-Based Health Insurance (CBHI). Methods A hospital-based cross-sectional study was conducted at St. Amanuel Mental Specialized Hospital, Addis Ababa, including 348 schizophrenia patients (50% CBHI-enrolled) on follow-up. Data were collected via face-to-face interviews using structured questionnaires. Direct/indirect costs were measured using human capital approach, with catastrophic health expenditure (CHE) assessed at 10%, 15%, 25%, and 40% thresholds. Multivariable logistic regression analyzed CBHI's effect on CHE. Results Participants mean age was 35 years (62.9% male). The mean annual OOP costs were: medical (2,260.83 ETB/41.23 USD), non-medical (760.12 ETB/13.87 USD), and productivity loss (3,258.29 ETB/59.29 USD). CHE incidence at 15% non-food threshold was 36.7% for CBHI members versus 48% for non-members (p < 0.05). Conclusions CBHI significantly reduces CHE incidence among schizophrenia patients, though indirect costs remain burdensome. Policy interventions to expand insurance coverage and address productivity losses are urgently needed.