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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 7, Issue 1, 2004. Pages: 23-28

Published Online: 15 Mar 2004

Copyright © 2004 ICMPE.


 

Out-of-Pocket Expenditure for Depression Among Patients Attending Private Community Psychiatric Clinics in Pakistan

Amin A. Gadit

MD, Head of Psychiatry Department, Hamdard University, Hamdard University Hospital, Taj Medical Complex, M. A. Jinnah Road, Karachi, Pakistan

* Correspondence to: Prof. Amin A. Gadit, Hill View Appt., KMCHS, Hill Park, Karachi, Pakistan
Tel.: +92-021-453 4210
Fax: +92-021-431 1316
E-mail: aa-gadit@cyber.net.pk

Source of Funding: Wyeth Pakistan Ltd.

Abstract

Depression is a serious public health problem in Pakistan because of the disabilities it causes and the cost burden for the family, given the very low health budget, an average per capita income of $ 430 and the fact that more than 35% of the population falls below the poverty line. A prevalence-based analytic study was conducted on 200 patients with ICD-X diagnosis of depression attending four private community psychiatric clinics
in Karachi (Pakistan). Of the 200 subjects enrolled, 85% were spending US$ 51.40 per month on general health expenses and 65% were earning below US$ 86 per month. All costs, including consultation fees, medicine, transportation, laboratory tests and hospitalization (if any) were paid out-of-pocket. As this situation is causing a heavy economic burden on the public, increasing the health budget and enhancing preventive efforts are essential, and further research on health economics is needed along with an appropriate government database.

 

Background: Depression is a serious public health problem in Pakistan because of the disabilities it causes and the cost burden for the family. About 6% of the Pakistani population suffers from this illness and approximately 50% of those affected seek treatment. The health budget of the country is very low, average per capita income is US$ 430 and 35% of the population falls below the poverty line. It follows that depression puts a heavy economic burden on its sufferers.
Aim: The aim of this study was to estimate the economic burden on patients suffering from depression who were attending community psychiatry clinics.
Methods: This is a prevalence-based analysis of mental health care expenditure in a sample of 200 patients with an ICD-X diagnosis of depression. The patients attended four private community clinics, run on a once-a-week basis, with all care paid for by the patients out of pocket. A questionnaire was designed with a view to gathering information on out-of-pocket treatment and travel expenditures. The data was subjected to SPSS analysis.
Results: Among the subjects enrolled in the study (n=200), 85% were spending over Rs. 3,133 (US $ 51.40) per month as general expenses on health. Sixty-five percent of the subjects were earning below Rs. 5,000 (US $ 86.00). The majority used the public bus for transportation, costing the family Rs. 83 (US $ 1.40) per trip. Laboratory investigation costs were negligible as there is a lesser emphasis on lab tests in psychiatry.
Discussion: The high cost of depression keeps a vast majority of the population away from ongoing treatment, which contributes to the misery of the illness and the associated loss of productivity. The national budget is very low, the average income for the majority is far from satisfactory, and though partial support from charitable organizations, public sector hospitals, insurance cover and medical facilities is available, the majority of needs are unmet. It is essential to increase the health budget and enhance efforts toward preventive strategies. Further research on health economics is needed along with an appropriate government database.


Received 27 January 2003; accepted 25 September 2003

Copyright 2004 ICMPE