Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Melinda Pettigrew

Second Advisor

Michael Boozer



Background: Chronic and acute illnesses pose substantial economic burden on households due to explicit health expenses and implicit costs engendered by decreased productivity and increased time allocation to care provision. This study examined economic coping mechanisms employed by households to respond to health shocks represented by chronic and acute morbidities.

Methods: Data from Kagera Health and Development Survey (1991-2004) were utilized to examine household health status and economic coping. Pooled OLS regression models were used to analyze the association between household health status and economic burden and coping mechanisms controlling for household size, mean age, income, and characteristics of household head. Household health status was categorized as chronic, acute, or healthy, economic burden was characterized by health expenditures, and coping variables examined included assets, transfers, and debt. Fixed effects regression models were employed to assess variations in household economic indicators and coping strategies corresponding to changes in health status over time.

Results: Pooled regression analysis did not indicate significant associations between health status and economic burden and coping strategies. Fixed effects model revealed that entry into chronic and acute status was significantly associated with increases in health expenditures (p value 0.01). The marginal propensity to spend on health expenses given additional transfers was 0.22 for acute households (p value 0.01).

Conclusion: Although health status overall did not significantly explain economic coping, developing acute and chronic illnesses was associated with larger health expenditures with chronic status being associated with the biggest increase. Transfers played a significant role in funding health expenses for acute households, and chronic households appear to have relied on self-insurance.


This is an Open Access Thesis.

Open Access

This Article is Open Access