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Evidence of High Out of Pocket Spending for HIV Care Leading to Catastrophic Expenditure for Affected Patients in Lao People's Democratic Republic

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  • Hubert Barennes
  • Amphonexay Frichittavong
  • Marissa Gripenberg
  • Paulin Koffi

Abstract

Background: The scaling up of antiviral treatment (ART) coverage in the past decade has increased access to care for numerous people living with HIV/AIDS (PLWHA) in low-resource settings. Out-of-pocket payments (OOPs) represent a barrier for healthcare access, adherence and ART effectiveness, and can be economically catastrophic for PLWHA and their family. We evaluated OOPs of PLWHA attending outpatient and inpatient care units and estimated the financial burden for their households in the Lao People's Democratic Republic. We assumed that such OOPs may result in catastrophic health expenses in this context with fragile economical balance and low health insurance coverage. Methods: We conducted a cross-sectional survey of a randomized sample of routine outpatients and a prospective survey of consecutive new inpatients at two referral hospitals (Setthathirat in the capital city, Savannaket in the province). After obtaining informed consent, PLWHA were interviewed using a standardized 82-item questionnaire including information on socio-economic characteristics, disease history and coping strategies. All OOPs occurring during a routine visit or a hospital stay were recorded. Household capacity-to-pay (overall income minus essential expenses), direct and indirect OOPs, OOPs per outpatient visit and per inpatient stay as well as catastrophic spending (greater than or equal to 40% of the capacity-to-pay) were calculated. A multivariate analysis of factors associated with catastrophic spending was conducted. Results: A total of 320 PLWHA [280 inpatients and 40 outpatients; 132 (41.2%) defined as poor, and 269 (84.1%) on ART] were enrolled. Monthly median household income, essential expenses and capacity-to-pay were US$147.0 (IQR: 86–242), $126 (IQR: 82–192) and $14 (IQR: 19–80), respectively. At the provincial hospital OOPs were higher during routine visits, but three fold lower during hospitalization than in the central hospital ($21.0 versus $18.5 and $110.8 versus $329.8 respectively (p

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  • Hubert Barennes & Amphonexay Frichittavong & Marissa Gripenberg & Paulin Koffi, 2015. "Evidence of High Out of Pocket Spending for HIV Care Leading to Catastrophic Expenditure for Affected Patients in Lao People's Democratic Republic," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-20, September.
    • Handle: RePEc:plo:pone00:0136664
    DOI: 10.1371/journal.pone.0136664
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    1. María del Carmen Pérez-Peña & Mercedes Jiménez-García & José Ruiz-Chico & Antonio Rafael Peña-Sánchez, 2021. "Transport Poverty with Special Reference to Sustainability: A Systematic Review of the Literature," Sustainability, MDPI, vol. 13(3), pages 1-13, January.
    2. Evelyn, Lee & Limin, Mao & John, de Wit & John, Rule & Andrew, Carr & Krista J, Siefried, 2021. "Impact of the removal of patient co-payments for antiretroviral therapy (ART) on out-of-pocket expenditure, adherence and virological failure among Australian adults living with HIV," Health Policy, Elsevier, vol. 125(9), pages 1131-1139.
    3. Sushil Koirala & Keshab Deuba & Oranuch Nampaisan & Gaetano Marrone & Anna Mia Ekström & for the CAT-S group, 2017. "Facilitators and barriers for retention in HIV care between testing and treatment in Asia—A study in Bangladesh, Indonesia, Lao, Nepal, Pakistan, Philippines and Vietnam," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-20, May.

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