Overview

This study investigates how socio-economic inequalities affect catastrophic health expenditures (CHE) related to hypertension management in Ghana. Despite the country’s social health insurance policy, many patients still face major out-of-pocket costs that can drive households into financial hardship.

Methods

A Catastrophic Health Expenditure (CHE) survey was conducted across two primary health facilities in the Greater Accra Region (Dec 2023 – Feb 2024).

• Sample size: 382 patients diagnosed with hypertension.
• Analysis: Bayesian logistic regression and decomposition of the Concentration Index (CI) to measure and explain inequality drivers.
• Data Imputation: Missing data were handled using the Random Forest method (missForest package in R), ensuring robust results.

Key Findings

• Higher socioeconomic status (SES) was associated with greater absolute spending on hypertension management.
• However, catastrophic health expenditure was more concentrated among poorer households (negative CI).
• Socioeconomic status was the largest contributor (24.8%) to inequality in CHE.
• Factors such as education, age, transport cost, gender, and physical activity also contributed but to a lesser extent.
• Women, the elderly, and those with lower education levels were more likely to experience catastrophic health costs.

Conclusions

Even with Ghana’s National Health Insurance Scheme, financial protection for hypertension care remains unequal.

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