Introduction: In a national context of increasing urban populations and commitment to universal health coverage, this study aims to analyze the household income and health care expenditure in the city of Goma, Eastern DRC.Methodology: This descriptive cross-sectional study was based on a 2017 survey of a sample of 1,000 households in the urban and suburban areas of the City of Goma on household income and health care expenditures during the last episode of illness. Data was analyzed by SPSS version 23.Results: The median monthly household income was 140 Usd, with 89.9% of households living on less than 1.9 Usd per day. Only 9.1% of households were covered by a health insurance system and 91.6% of households experienced at least one illness episode in the past three months. The use of care were dominated by self-medication by purchasing drugs from the pharmacy (50.7%), with non-care cases (6.8%), and varied by income quartile and gender (p <0.001). The median direct care expenditure was 10.7 Usd (0-2272.5 Usd), with catastrophic expenditures in 42.9% of cases and loss of working days and income, not varying according to income quartile (p> 0.05).Discussion and conclusion: This level of income and catastrophic healthcare expenditure requires progress towards a better thought-out compulsory health insurance system that capitalizes on innovative financing.