The effect of wealth status on care seeking and health expenditures in Afghanistan

This paper analyses the effect of wealth status on care-seeking patterns and health expenditures in Afghanistan, based on a national household survey conducted within public health facility catchment areas. We found high rates of reported care-seeking, with more than 90 % of those ill seeking care. Sick individuals from all wealth quintiles had high rates of care-seeking, although those in the wealthiest quintile were more likely to seek care than those from the poorest (odds ratio 2.2; 95 % CI 1.6, 3.0). The nearest clinic providing the government’s Basic Package of Health Services (BPHS) was the most commonly sought first provider (53 % overall), especially for relatively poor households (62 % in poorest vs. 42 % in least poor quintile, P<0.0001). Sick individuals from wealthier quintiles used hospitals and for-profit private providers more than those in poorer quintiles. Multivariate analysis showed that wealth quintile was the strongest predictor of seeking care, and of going first to private providers. More than 90 % of those seeking care paid money out-of-pocket. Mean (median) expenditures among those paying for care in the previous month were 87