Effects of Out-of-Pocket Medicine's Spending on Catastrophic Expenditure and Impoverishment in Tunisia

Abstract

Objectives: This study aimed to estimate and analyze the effects of out-of-pocket expenditure attributed to medicine on catastrophic health expenditure (CHE) and impoverishment. Our study also explored the determinants of CHE for Tunisian households.

Methods: CHE and impoverishment were estimated using the representative sample of 25 087 households' survey of Budget, Consumption, and Living Standards in 2015. Logistic regression was applied to determine factors associated with the CHE.

Results: The occurrence of catastrophic expenditure on health and medicine from the total population was, respectively, estimated to be 18.4% and 8.0%, whereas the impoverishment was 2.8% and 1.8%. The catastrophic expenditure was high in households having a chronic disease, disability, elderly, and children younger than 5 years and those living in a rural area. The rich and insured households are also experiencing financial hardship.

Conclusions: Out-of-pocket expenditure for medicine generates high levels of catastrophic and impoverishment in Tunisia. To achieve universal and affordable access to medicine, policy makers should remove fees at public facilities for patients with chronic diseases and disabilities, consolidate public procurement and distribution, and ensure effective reimbursement of health insurance.

Keywords: Tunisia; financial protection; medicines; out-of-pocket expenditure.