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Abstract
Brazil is a nation with both a large urban slum population as well as a large burden of disease for acute febrile illness (AFI). While the global average of the population living in urban areas is just 49%, in Brazil 86% (1.66 million) of the total population are urban dwellers and 45.7 million live in urban slums. Due to overcrowding and lack of proper sanitation the urban slum population within Brazil are at high risk to the numerous acute febrile illnesses that are endemic to Brazil. This study uses data collected from 151 households from a Brazilian urban slum in order to measure the total out-of-pocket costs associated with treatment for an episode of acute febrile illnesses. Furthermore, this study assesses the economic burden on the household through the analysis of catastrophic health expenditure and coping strategies used to address the out-of-pocket costs of illness. Lastly, the study estimates the relationship between demographic factors, income, chronic illness, and hospitalization and usage of private pharmacy on out-of-pocket health care cost. This study establishes that the average cost of an episode of acute febrile illness was $11.74 and 9.9% of households in the study incurred health care costs of 40% or more of their non-food related expenditure. The households that incurred catastrophic costs used a significantly higher number of coping strategies and were more likely to borrow money to pay for the illness. The most significant determinants of increased out-of-pocket health care costs were having at least one chronic medical condition, being hospitalized, and obtaining medication from a private pharmacy. This study found that within this urban slum population, even modest out-of-pocket expenses for treatment of acute febrile illness could have a large economic burden on this vulnerable population.
