Out-of-pocket expenditures and coping strategies for people living with HIV: Bogotá, Colombia, 2009

Abstract

Our objective was to estimate the out-of-pocket expenditure related to medical and non-medical items on health care covered by individuals or household members, and to describe coping strategies they use to meet the financial burden. We undertook a cross-sectional survey with a convenience sample of 540 adults with HIV living in urban areas of Bogotá, Colombia. Univariate and bivariate analyses were done. We found that although 95% of the patients with HIV in the sample had health insurance, individuals and families spent about 13% of their incomes on medical and non-medical items monthly. Those costs increased for patients taking the second or third antiretroviral drug (ARV) treatment scheme and for patients with AIDS-related physical disabilities. We found statistically significant differences in spending among different insurance plans and socioeconomic status (SES; p≤0.05). As a result of the high out-of-pocket expenses, households had to alter their budgets, reducing consumption of basic needs and modifying financial and social family dynamics. Those coping strategies might increase both current and structural poverty. Lack of comprehensive health care increases the economic burden for patients, in terms of financial but also social impact.

Keywords:

• HIV infections
• out-of-pocket expenditures
• access to health services

Acknowledgements

This work was co-funded by Colciencias, National University of Colombia, University of Toronto, University of Antioquia, as well as a grant from the Government of Canada International Scholarship Program. We thank all participants for sharing their experiences with us, the institutions who cooperate to collect data. We also thank to Dr. Jorge Martínez and Dr. Carlos Tangarife for their support in the method used, and Dr. Leonardo Uribe for manuscript revision.