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Impact of Catastrophic Out-of-pocket Health Expenditure on Households

Impact of Catastrophic Out-of-pocket Health Expenditure on Households. Ke Xu GPE/EIP/WHO. Health Care and Poverty: Solution Ahead? December 2003, Antwerp, Belgium. Overview of Catastrophic Health Expenditure.

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Impact of Catastrophic Out-of-pocket Health Expenditure on Households

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  1. Impact of Catastrophic Out-of-pocket Health Expenditure on Households Ke Xu GPE/EIP/WHO Health Care and Poverty: Solution Ahead? December 2003, Antwerp, Belgium

  2. Overview of Catastrophic Health Expenditure • When the medical bills of one or more of their members are high in relation to their capacity to pay, households must reduce their expenditure on other necessities for a period of time. This is catastrophic expenditure. • the percentage of households with catastrophic health expenditure ranges from less than 0.1% up to 10.5% • This results in more households living under the poverty line. • impoverishment attributable to health payments ranges from less than 0.1% to 5%

  3. VNM 5 4 BRA 3 COL % of impoverish households AZE ARG BGD GHA KHM 2 BGR UKR PRY JAM LBN EGY NIC LVA LKA PER SEN PAN KGZ YEM IDN MAR 1 ZMB PRT EST MEX PHL GUY MUS THA LTU NAM HRV ROM DJI HUN CRI GRC USA ZAF KOR ISR SVK ESP CZE FRA DEU GBR SVN DNK CAN BEL SWE NOR ISL FIN CHE 0 0 2 4 6 8 10 % of catastrophic households Catastrophic Expenditure and Impoverishment

  4. What Has Been Done? • Study: • cross-country study on understanding system level characteristics associated with a higher proportion of households facing catastrophic out-of-pocket payment (59 countries) • Data: • household survey data (59 countries) • Possible explanatory variables: • service supply (total health expenditure share of GDP) • risk sharing (out-of-pocket expenditure share of total health expenditure, OOP%THE) • households’ capacity to pay (% of poor)

  5. 13.5 VNM BRA AZE COL ARG LBN KHM 4.9 UKR PRY PER EGY LVA PRT PAN ZMB GRC NIC BGR JAM 1.8 KOR YEM MEX LTU GHA MUS IDN LKA BGD THA PHL .70 KGZ GUY CHE USA SEN ESP FIN % of households with catastrophic expenditures ISR due to out-of-pocket payments (logarithm) DJI EST ISL NOR .30 HUN HRV SWE MAR CRI NAM BEL CAN ROM .09 DNK SVN GBR .03 ZAF DEU .01 FRA 3.0 5.0 8.0 14.0 22.0 37.0 61.0 100 , OOP%THE (logarithm) Proportion of Households with Catastrophic Expenditures vs. Share of Out-of-pocket Payment in Total Health Expenditures (OOP%THE)

  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. Country Case Studies-Key Issues • Who uses health services? • Who pays how much and for what kinds of health services? • How those payments impact on a household’s financial situation? • What kinds of households are more likely to face catastrophic expenditure?

  8. Ongoing Activities • Building country capacity to analyze micro level data • identify data sources with countries WHS, LSMS, SES, ... • develop guidelines for data analysis • conduct training workshops • provide technical support • Facilitate policy dialogue

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