Objectives: This study investigated the level and associated factors, focusing on the number of individuals with chronic conditions, of OOPHEs.

Methods: A cross-sectional study design was used among households in Riyadh Province from the beginning of January 2021 to the end of June 2021. Face‑to‑face interviews using a pretested patient interview questionnaire were conducted with households' heads. The respondents were asked to report the OOPHE incurred in the previous three-month period when receiving health services. A generalized linear regression model (GLM) using Box-Cox transformation was used to determine the effects of predisposing, enabling, and need factors on the level of OOPHE. Quantile regressions were employed to assess the association between the number of individuals with chronic conditions in a household and OOPHE along with the OOPHE distribution.

Results: The average household OOPHE among all the surveyed households (N=1,176) was SAR 1775.3, for households affected by one chronic condition (one-CCA households), households affected by more than one chronic condition (more-than-one-CCA households) were SAR1806 and SAR2704, respectively. At the household level, the increased number of family members with chronic conditions, the presence of a member less than 14 years old, higher SES status, coverage from health insurance plans, residence in an urban area, and the presence of a member with a disability in the household, were correlated with a considerably greater level of OOPHE (p<.0001). The result of quantile regression analysis indicates that an increase in the number of members with chronic conditions in a household was significantly associated with greater overall OOPHE at higher health expenditure quantiles.

Conclusions: The burden of OOPHE on households with chronic conditions remains heavy, and some disparities still exist.