ArticleJournal of health, population, and nutrition2026
Health-seeking behavior and the related out-of-pocket expenditure for noncommunicable diseases in Erbil, Iraq: a quantile regression analysis.
Article in Journal of health, population, and nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNoncommunicable diseases (NCDs) are complex and chronic in nature, often requiring long-term follow-up and care, which can lead to increased healthcare costs. This study aimed to evaluate health-seeking behavior and out-of-pocket healthcare expenditures for NCDs among patients in Erbil, Iraq.
methodsThis cross-sectional study involved a convenience sample of adult patients with NCDs visiting a private internal medicine center in Erbil City. A questionnaire was used to collect data on sociodemographic characteristics, NCD characteristics, health-seeking behavior, and the average monthly cost of NCDs. Multiple quantile regression analysis was performed to examine the variables associated with the total cost.
resultsMost participants get their NCD medicines from private pharmacies through out-of-pocket payments (96.0%). The median (IQR) cost of medications for NCDs per month was 70,000 (35,000-125,000) Iraqi Dinars (IQD), i.e., approximately US$48.3 (24.1-86.2). The median total out-of-pocket expenditures for all aspects of NCDs was 106,000 (60,000-184,500) IQD, i.e., approximately US$73.1 (41.4-126.9). Most participants indicated that out-of-pocket expenses for NCD treatment constitute an important financial burden on their households (74.4%). The total out-of-pocket expenditure for NCDs per month was statistically significantly higher among older age group (P < 0.001), those with no formal education (P = 0.002), those not working or with manual work (P = 0.003), those have more NCDs (P < 0.001), those with cardiovascular diseases (P < 0.001), those who get their medications from the private sector, those with better control of their NCDs (P = 0.002), those with complications of NCDs (P < 0.001), and those with good adherence (P = 0.001).
conclusionThis study reveals the significant financial burden caused by out-of-pocket expenditures for NCD care. As most individuals with NCDs rely on private pharmacies for medication, the associated costs, particularly for those managing multiple conditions, represent a substantial challenge for households. There is a need for improved financial protection mechanisms and expanded access to affordable NCD care. Future research should examine the impact of health insurance coverage and public-sector interventions on reducing out-of-pocket expenditures and improving access to NCD care in Iraq.
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