The Need for Catastrophic Health Coverage: A Case Study Among the Urban Poor in Pakistan

Background:- Naya Jeevan (http://njfk.org) provides catastrophic health care coverage to the urban poor of Pakistan.

Methods: - Data was collected during the annual health screenings of the card holders from 15th of October, 2009 to January 13th, 2011 using a detailed questionnaire. Hypertension(National Institute of Health criteria)and Obesity(World Health Organization cut-offs) were used as predictors of health care costs. Beneficiary income was divided into low (15,000 PKR and below) and high (<15,000 PKR). Data was entered and analyzed using SPSS (v 17).

Results :- In our screened population(n = 1011) the median monthly income was PKR 9600(IQR 8000-12000),the median health expenditure over past year was PKR 1200(IQR 800-2088),88.3 percent had an income of ≤ 15,000 PKR/month, 21.4 percent suffered from hypertension, and 10.98 percent had a BMI ≤ 30. 27.7 percent of the screened population had at least one of these two conditions. Obesity was more common in the high income category (p < 0.0001) while a statistically insignificant association was noted between socioeconomic status and hypertension (p = 0.114).The self reported health expenditures over the past year in individuals that had at least one of hypertension or obesity remained comparable (p = 0.765) in the low income (PKR 3298 +/- 10260, n= 161) and the high income group (PKR 3864 +/- 5609, n= 28). The median health expenditure/median monthly income ratio in individuals with at least one of hypertension or obesity was 15 percent as opposed to 12.63 percent for individuals without hypertension and obesity. 5.1 percent of the screened population spent more than half their monthly salary on health expenditures.

Conclusion:- Awareness of the need for primary and secondary prevention should be encouraged through preventive health workshops. In spite of significant risk for catastrophic health events such as heart attack expenditures on health remains low.