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Understanding Household Catastrophic Health Expenditure

Understanding Household Catastrophic Health Expenditure. Ke Xu, A M Aguilar-Rivera, David B Evans Health System Financing, Expenditure and Resource Allocation. Distribution of household financial contribution. Reduce other basic expenses Push some households into poverty

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Understanding Household Catastrophic Health Expenditure

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  1. Understanding Household Catastrophic Health Expenditure Ke Xu, A M Aguilar-Rivera, David B Evans Health System Financing, Expenditure and Resource Allocation

  2. Distribution of household financial contribution

  3. Reduce other basic expenses Push some households into poverty Forgo health services and suffer illness Catastrophic Health Expenditure Out-of-pocket health expenditures is equal to or more than 40% of household non-subsistence spending

  4. Percentage of Households at High Levels of Health Spending ( Some OECD countries)

  5. Percentage of Households Impoverished( Some OECD countries)

  6. Results from Cross Country Analysis • Higher percentage of households with catastrophic expenditure is associated with: • higher share of OOP in total health expenditure (low risk pooling) • higher percentage of population under poverty line • higher percentage of total health expenditure share of GDP (greater availability of health services) • Important message: The improvement of physical access could contribute to problem of catastrophic expenditure unless accompanied by financial protection mechanisms.

  7. Within country studies • e.g. Indonesia: SUSENAS (1999; 2000; 2001)

  8. Catastrophic Health Expenditure, Impoverishment and % not seeking care Catastrophic Impoverishment Not seeking care

  9. Utilization of Health Servicesby Expenditure Deciles 1999 2001 Source: Susenas 1999 and 2001. Core

  10. Percentage of Households at Different Levels of Health Spending Source: Susenas 1999, 2000 and 2001. Core

  11. Socio-economic Factors of Households Related to Catastrophic Expenditures (2001)

  12. Summary • At system level • the availability of health services, low capacity to pay, lack of prepayment or health insurance are leading to higher percentage of households with catastrophic expenditures • At household level • socio-economic characteristics have impact on catastrophic expenditure • poor households are excluded from the system

  13. Spare slides

  14. Methodology • System level hypothesis: • cross country analysis • double logarithmic multivariate ordinary least squares (OLS) regression • Individual household level hypothesis • within country studies • Logistic regression

  15. Data sources • Micro level data from 59 countries’ household survey data conducted between 1991 and 2000 • Living standard measurement survey • Household budget survey • Household income expenditure survey • others • National level data • total health expenditure share of GDP (NHA & surveys) • out-of-pocket payment share of total health expenditure (NHA & surveys) • percentage of population under the poverty line (surveys)

  16. determinants of catastrophic health expenditure from cross country analysis

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