ArticleBMC health services research2020
Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal.
Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Healthcare use and costs among individuals receiving mental health services for depression within primary care in Nepal.BMC health services research · 2022Trial
- Aging, Mental Health and Ethnic Disparities: Understanding Geriatric Mental Health in Western Nepal.Journal of geriatric psychiatry and neurology · 2026Article
- Global and regional quality of care index in major depressive disorder: the global burden of disease study 2021.International journal for equity in health · 2026Article
- Does healthcare expenditure matter equally for all mental disorders? An international approach employing dynamic panel data methods.Cost effectiveness and resource allocation : C/E · 2026Article
- Mental health and catastrophic health expenditures in conflict-affected regions of Colombia before and during COVID-19: an inequalities perspective.International journal for equity in health · 2025Article
- Prevalence and Risk Factors of Type 2 Diabetes Mellitus among Depression Inpatients from 2005 to 2018 in Beijing, China.Health data science · 2025Article
- Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study.JMIR human factors · 2024Article
- Beyond reducing direct medical cost: examining health outcomes in tuberculosis through a difference-in-differences analysis of South Korea's out-of-pocket payment exception policy.Frontiers in public health · 2024Article
- The Economic Burden of Chronic Diseases with Co-Occurring Depression and Alcohol Use Disorder for People in the Western Cape, South Africa.SSM. Mental health · 2023Article
- Excess healthcare costs of psychological distress in young women: Evidence from linked national Medicare claims data.Health economics · 2023Article
- Burden of coronary heart disease in Nepal: current status.The British journal of cardiology · 2021Article
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6 authors.
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Abstract
backgroundDespite attempts to improve universal health coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal.
methodsWe analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more.
resultsWe classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7-22%, p < 0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p < 0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD).
conclusionsIn this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.
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