Abstract
BACKGROUND: Noncommunicable 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. METHODS: This 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. RESULTS: Most 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). CONCLUSION: This 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.