A disaggregated analysis of catastrophic and impoverishing health expenditure in Ghana

Achieving universal health coverage (UHC) requires, among others, removing financial barriers to health care. In developing countries like Ghana where risk pooling arrangements are less developed, out-of-pocket (OOP) payments can have substantial economic implications on households and threaten progress towards UHC. This study estimates sub-national catastrophic health expenditure (CHE) and resultant impoverishment using the seventh round of the Ghana Living Standards Survey. We found that while CHE and impoverishment declined over time there are significant subnational variations. CHE was highest in rural locations and regions associated with high poverty including the northern regions, Volta, Central, and Eastern with scores exceeding the national average of 1.385 % at the 10 % threshold. We also found CHE and impoverishment to be concentrated among economically disadvantaged households with factors such as poverty, household size, and locality of residence contributing to the observed inequality. The findings emphasize the need for interventions to reduce OOP payments and proper targeting of deprived regions.