BACKGROUND: High burden of out-of-pocket health care expenditure is a known factor that affects universal access health care, in general and acute care more specifically. The aim of this study was to assess the burden of out-of-pocket payment in acutely ill patients in emergency department.

METHODS: A cross-sectional study was conducted by reviewing patient record visited St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia in study period. Data were analysed using SPSS Version 25. Descriptive statistics was used to summarize the finding.

RESULTS: A total of 22,982 clients were seen, with 388 eligible charts examined. Participants ranged in age from 15 to 100 years, with a mean age of 49.84 ± 18.21 years. The male-to-female ratio among participants was 1.3:1. Most participants were from Addis Ababa (52.8%), followed by Oromia (31.4%). Among the specified payment methods, out-of-pocket payments were the most prevalent at 35.8%, followed by community-based health insurance at 15.5% and government fee waivers at 13.7%.

CONCLUSION: Out-of-pocket payments were the predominant method of payment, followed by Community-Based Health Insurance (CBHI) and government waivers. Out-of-pocket spending consistently exceeded other payment methods across all age groups, both genders, various geographic regions, referral sources, and among individuals with comorbid conditions.

KEYWORDS: out of pocket payment, emergency service, health care expenditure.