Socioeconomic inequality of financial hardship to access quality healthcare services in Ethiopia: A Community based cross-sectional study

Yawkal Tsega ^* Zelalem Birhan Kidist Adamu

• Wollo University, Dessie, Ethiopia

The 2030 agenda for sustainable development aims to ensure no one is left behind in health. However, the high magnitude of Catastrophic Health Expenditure (CHE) and Impoverishing Health Expenditure (IHE) remain global challenges. The financial hardship of healthcare has not been well studied in Ethiopia so far. Therefore, this study aimed to assess socioeconomic inequalities of financial hardship and its determinants among households in South Wollo zone, Ethiopia.This cross-sectional study surveyed 845 households in South Wollo zone from May 1 to 31, 2023. Financial hardship was measured using IHE and CHE metrics. The IHE and CHE were considered if households to be pushed below a $2.15 (ETB 118.25) poverty line due to health expenditure and if share of households' health expenditure exceeds 10% of their total expenditure, respectively. Costs were estimated using prevalence-based and patient perspective approaches.The STATA version 17.0 statistical software was used for data management and analysis. We used cixr and lorenz estimate STATA commands to estimate concentration index (CIX) and sketch concentration curve, respectively. Adjusted Odds Ratio (AOR) with 95% confidence interval and P<0.05 were used to determine statistical significance.The CIX for wealth status was -0.17 (CI: -0.23, -0.11) with P<0.001, indicated the significant socioeconomic inequality in financial hardship of healthcare. The incidence of CHE was ~30% (95%CI: 26.91-33.16%) at 10% threshold, and IHE was ~4% at $2.15 poverty line.