Chronic disease costs push Cavite families to borrow, cut back — study

MANILA, Philippines — Families in a low-income municipality in Cavite often had to stretch their budgets to pay for medicines and other health care needs, with many turning to cheaper or alternative treatments, borrowing money or using their savings, a recent study by the University of the Philippines (UP) found.

The study surveyed 200 households across all 10 barangays of Ternate, a fourth-class municipality, and examined their out-of-pocket spending on noncommunicable diseases (NCDs), or chronic illnesses, as well as how they coped with health care costs.

It found that 61% of households sought alternative or cheaper treatments, while 39.5% borrowed money and 29% relied on existing funds or savings to pay for health care.

The financial burden was also reflected in the share of medicine costs in household health spending. NCD medicines accounted for a median 59.41% of total health expenditures, while all medicines combined accounted for 77.57%.

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The study also found that 74% of households incurred catastrophic health expenditure (CHE) when health spending was measured against the 10% threshold. At the higher 25% threshold, 30.5% of households still incurred CHE.

The researchers, however, cautioned that these figures cannot be generalized to all households in Ternate because households covered by Primary Care Benefit Packages were excluded from the study. The estimates, they said, “may overestimate the true prevalence of catastrophic health spending in the municipality.”

The findings came from the cross-sectional study, “Assessing Household Out-of-Pocket Expenditures for Non-communicable Diseases in a 4th Class Municipality: A Cross-sectional Study,” by Marivie R. Magana, Gwyneth Allyson B. Ibarra, Charlene C. Laggui and Frances Lois U. Ngo of the Department of Clinical, Social and Administrative Pharmacy at the UP Manila College of Pharmacy.

The study was published in Acta Medica Philippina on Oct. 15, 2025.

Medicines eat up household health budgets

NCDs, also known as chronic diseases, are generally long-term conditions resulting from a combination of genetic, physiological, environmental and behavioral factors, according to the World Health Organization (WHO).

The four main groups are cardiovascular diseases such as heart attacks and stroke, cancers, chronic respiratory diseases such as chronic obstructive pulmonary disease and asthma, and diabetes.

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NCDs are also the world’s leading cause of death. WHO said at least 43 million people died from NCDs in 2021, equivalent to 75% of non-pandemic-related deaths globally. Nearly three-quarters of all NCD deaths, or about 32 million, occurred in low- and middle-income countries.

For people living with these conditions, the health burden can also mean years of regular treatment and medication. That long-term need was reflected in Ternate, where medicines accounted for the largest share of household health spending.

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The median monthly out-of-pocket spending on NCD medicines was P1,140, although expenses varied widely, from P70 to as much as P35,000 among the households surveyed. Nearly 6 in 10 households, or 59.5%, spent more than P1,000 a month on NCD medicines.

The researchers also found that household medicine costs rose as more family members needed treatment for NCDs. Their analysis estimated that health spending increased by P1,576.682 for every additional household member taking medicine for an NCD, a statistically significant finding.

“Medicine costs accounted for the highest share (77.57%) in household health spending,” the researchers wrote.

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The medicines most commonly recorded in the study included losartan and amlodipine, both used for hypertension, followed by metformin for diabetes and atorvastatin for high cholesterol.

The most common health conditions reported by the households were hypertension, diabetes, heart disease and asthma. More than half of the households had a member with only one NCD, although it was also common for household members to take medicines for two or three NCDs.

But the researchers said the burden was not simply about medicine prices. Whether households could find the medicines they needed also mattered.

The researchers noted that under the country’s devolved health system, commonly needed medicines should be available free through rural health units (RHUs) and barangay health stations (BHS). But they said this was not always the case.

“However, availability of NCD medicines in RHU and BHS is not always guaranteed,” they wrote.

When medicines were unavailable at public health facilities, households could buy them from private pharmacies instead. The researchers also noted that the lack of pharmacies in Ternate meant some residents had to travel to other towns to obtain medicines and other health care services.

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The researchers said the share of households spending more than P1,000 each month on NCD medicines could be linked to inadequate supplies of free medicines at the primary health care level or difficulty accessing medicines within the community.

Households also reported out-of-pocket spending on consultations, laboratory tests and diagnostic services.

Of the 200 households surveyed, 106 paid for outpatient care, 58 used inpatient services, 166 accessed laboratory services, and 85 underwent diagnostic imaging or related services.

While some of these services were covered by PhilHealth, the researchers said households could still incur additional expenses because some services were unavailable locally, patients had to travel to other health care providers, or insurance packages did not fully cover the treatment or procedure needed.

The researchers estimated that households spent an average of P8,522.80 a month on health care needs. This included an average of P2,140 for NCD medicines, P5,012.75 for inpatient care, P569.26 for outpatient services and P508.57 for additional health products.

3 in 4 households faced ‘catastrophic’ health spending

WHO defines catastrophic health spending as “out-of-pocket payments greater than 40% of capacity to pay for health care.” Under this measure, a household is considered to be facing catastrophic spending when health care costs take up a substantial portion of the money it has available after accounting for basic needs.

WHO said this “may mean the household can no longer afford to meet other basic needs (for example, food, housing, water, electricity and fuel for cooking and heating) or cannot afford to meet basic needs without drawing on savings, selling assets or borrowing.”

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The UP study used a different set of thresholds to measure CHE. Following the thresholds used for global reporting under Sustainable Development Goal 3.8.2, the researchers looked at households whose health spending reached 10% and 25% of total household expenditure or income.

Using the 10% threshold, 148 of the 200 households surveyed, or 74%, incurred CHE. At the higher 25% threshold, 61 households, or 30.5%, incurred CHE.

The researchers found that the number of household members with chronic diseases was associated with the likelihood of incurring CHE.

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At the 10% threshold, households with one member with an NCD had significantly lower odds of CHE, with an odds ratio of 0.316. In contrast, households with two members with NCDs had significantly higher odds, at 2.365, meaning they were more than twice as likely to incur CHE based on the study’s analysis.

At the 25% threshold, households with one member with an NCD again had lower odds of CHE, at 0.389, while households with three members with NCDs had nearly six times higher odds, at 5.877.

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“There is a high prevalence of incurred CHE for non-communicable diseases in both the 10% threshold (74.00%) and 25% threshold (30.50%) in the 4th class municipality of Ternate, Cavite,” the researchers summarized.

They said this pattern was consistent with previous research showing that people with multiple chronic conditions tend to face higher out-of-pocket medicine costs.

They stressed, however, that the CHE estimates should be interpreted cautiously because households covered by the Primary Care Benefit Package were excluded.

Because of the exclusion, the researchers said, “these estimates cannot be generalized and may overestimate the true prevalence of catastrophic health spending in the municipality.”

Borrowing, savings used to pay for care

As health care expenses piled up, households in Ternate reported turning to different ways of finding money or reducing what they spent on care.

The researchers noted that families facing CHE struggled to keep up with out-of-pocket health care costs, with medicines taking up a substantial share of their health and household budgets.

“In a low-income setting, households incurring CHE struggle to afford OOP expenses for health, with medicine prices accounting for a substantial share in health and household spending,” they wrote.

“This brings households in low-income municipalities like Ternate, Cavite to adopt alternative coping strategies that help increase total budget and reduce total household expenses,” the researchers added.

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Borrowing money was the most common way households raised additional funds. Of the 200 households surveyed, 79, or 39.5%, reported borrowing to pay for medicines and other health care needs.

Among households that incurred CHE, borrowing remained the most common strategy, used by 40.54% of those who crossed the 10% threshold and 45.90% of those who crossed the 25% threshold.

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Other households reported asking family members for additional money, seeking medical assistance from government agencies or politicians, joining cooperative savings schemes or “paluwagan,” and, in some cases, engaging in illegal gambling or “jueteng.”

But borrowing was not the only way families tried to keep up with health care costs. Some relied on money they already had, while others tried to make treatment itself cheaper.

Across all 200 households, 29% relied on existing funds or savings, while 61% sought alternative or cheaper treatments.

Among households with CHE, seeking alternative or cheaper treatment was the most common way of reducing health care expenses. It was reported by 62.16% of households at the 10% threshold and 72.13% at the 25% threshold.

The researchers said this included choosing less expensive medicines, alternative treatments or generic drugs.

“Amongst them, seeking alternative treatment or cheaper treatment for illness was most common where households opt to buy less expensive, alternative treatment or generic medicines to reduce costs,” they wrote.

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Other households reduced spending on day-to-day needs. Among those with CHE, 33.11% at the 10% threshold and 34.43% at the 25% threshold reported reducing expenditures for household needs. Meanwhile, 16.89% and 19.67%, respectively, said they delayed or stopped treatment.

The researchers also documented more difficult choices among some households, including reducing spending on food, withdrawing children from school or sending them to work to help address the financial burden. Some households obtained medicines from relatives or neighbors.

The researchers cautioned that while borrowing money, using savings or cutting expenses may help households pay for health care in the short term, these strategies can carry longer-term financial consequences.

“However, even with the ability to pay for short periods, these risks may still push households further into poverty due to potential longer-term economic consequences,” they wrote.

Not everyone regularly sought medical care

The financial burden also coincided with gaps in the use of outpatient health care.

Of the 200 households, 106 paid for outpatient care, while some households did not regularly visit health care facilities.

“This is a concerning scenario, as it indicates that a considerable portion of the population may not be receiving the necessary medical attention for managing their health conditions effectively. Not availing outpatient care services for regular consultations and checkups can lead to several critical issues,” the study warned.

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The researchers also pointed out that regular consultations allow health care providers to monitor patients and adjust medicines when needed. Without regular medical oversight, patients may miss guidance on managing their conditions, including diet, lifestyle changes and monitoring.

They said some households did not seek outpatient care because of accessibility problems, geographic barriers and inconvenient clinic hours.

Medication adherence, health literacy

The study also found that 35% of households reported medication nonadherence, or not following their prescribed medication regimen as recommended by their health care provider.

The researchers explained that nonadherence can be influenced by social and economic circumstances, as well as treatment, disease, patient and health care system factors.

“These factors could affect intentional and unintentional non-adherence,” they stressed.

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The researchers also encountered difficulties when asking respondents to identify medicines. Some had prescriptions or purchase receipts, while others could not remember the names of their medicines and instead described them by their purpose or appearance.

“Most respondents, even though they are the most knowledgeable about the health status and expenditures of their households, trust the healthcare providers’ instructions implicitly,” the researchers wrote, adding that this could be related to “the varying levels of health literacy among respondents.”

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The researchers said the finding showed the importance of clearer patient education when medicines are prescribed and dispensed.

“This finding shows the importance of healthcare professionals’ patient education during prescribing and dispensing so that the health literacy of patients is improved, ensuring they understand and remember their medications accurately,” they wrote.

What the study recommends

The researchers said the findings could help the Ternate local government develop health programs targeting the most common chronic diseases in the municipality, particularly hypertension, diabetes and dyslipidemia.

They recommended strengthening local health services, including “operationalizing a Botika ng Barangay and improving the RHU services” to make health care and medicines more affordable and accessible.

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They also called for stronger implementation of existing health laws and programs to reduce household spending on medicines.

“Given the high prevalence of CHE determined for households in the study, there is still a need to strengthen these existing laws and programs, and continuously assess to improve policy implementation to help further reduce the health expenditures of households particularly on medicines,” they wrote.

For future research, the authors recommended studying more municipalities and diseases, as well as examining health-seeking behavior and whether insurance, subsidies and other financial-protection programs are reducing catastrophic health spending. /dm