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Household catastrophic health expenditure: evidence from Georgia and its policy implications

Open access
Gotsadze, George, Zoidze, Akaki, Rukhadze, Natia·2009·BMC Health Services Research
DOI 10.1186/1472-6963-9-69PMC PMC2695816
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Abstract

Background: To quantify extent of catastrophic household health expenditures, determine factors influencing it and estimate Fairness in Financial Contribution (FFC) index in Georgia to establish the baseline for expected reforms and contribute to the design and fine-tuning of the major reforms in health care financing initiated by the government mid-2007. Methods: The research is based on the nationally representative Health Care Utilization and Expenditure survey conducted during May-June 2007, prior to preparing for new phase of implementation for the health care financing reforms. Households' catastrophic health expenditures were estimated according to the methodology proposed by WHO – Ke Xu [1]. A logistic regression (logit) model was used to predict probability of catastrophic health expenditure occurrence. Results: In Georgia between 2000 and 2007 access to care for poor has improved slightly and the share of households facing catastrophic health expenditures have seemingly increased from 2.8% in 1999 to 11.7% in 2007. However, this variance may be associated with the methodological differences of the respective surveys from which the analysis were derived. The high level of the catastrophic health expenditure may be associated with the low share of prepayment in national health expenditure, adequate availability of services and a high level of poverty in the country. Major factors determining the financial catastrophe related to ill health were hospitalization, household members with chronic illness and poverty status of the household. The FFC for Georgia appears to have improved since 2004. Conclusion: Reducing the prevalence of catastrophic health expenditure is a policy objective of the government, which can be achieved by focusing on increased financial protection offered to poor and expanding government financed benefits for poor and chronically ill by including and expanding inpatient coverage and adding drug benefits. This policy recommendation may also be relevant for other Low and Middle Income countries with similar levels of out of pocket payments and catastrophic health expenditures.

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  • The incidence of catastrophic health expenditure in sub-Saharan Africa was lower than in China in the last decade but higher than in Europe, Asia, and South America, irrespective of the definition used.

    “The incidence of catastrophic health expenditure we found in sub-Saharan Africa was lower than in China in the last decade,139 but higher than in Europe,140–142 Asia,134,143,144 and South America,145,146 irrespective of the definition used.”

    From Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis (2022) · cites this paper as [141]

    The Results report an 11.7% incidence of catastrophic health expenditure in Georgia, providing a European-country estimate for the comparison. The Discussion cautions that international comparisons have methodological limitations. Neither passage establishes that sub-Saharan Africa’s incidence was higher than Europe’s, irrespective of definition. (LLM, conf=0.82)

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Research works printed but not linked: 7

  1. Xu K, Aguilar A, Carrin G, Evans DB, Hanvoravongchai P, Kawabata K, Klavus J, Knaul F, Murray CMJ, Ortiz JP, Zeramdini R, Annan S, Doorslear EV: Distribution of health payments and catastrophic expenditures Methodology. 2005, World Health Organization, Discussion Paper, Number 2
  2. The World Bank: 2004, Georgia: Review of the Health Sector. Report No. 29413 -GE. Washington
  3. Georgia Primary Health Care Development Project, MoLHSA, Department of Statistics, Ministry of Economic Development, Oxford Policy Management, UK, Curatio International Foundation (CIF). Georgia Health Utilization and Expenditure Survey (HUES), Results f r om household survey on the use of health services and expenditure on Health, Final report. 2007
  4. The world health report 2000: health systems. 2000, Geneva: World Health Organization
  5. Greene W: Econometric analysis. 1997, New Jersey: Prentice Hall International Inc
  6. Saksena P, Xu K, Carrin G: The Impact of Universal Insurance Program on Catastrophic Health Expenditure: Simulation Analysis for Kenya. 2006, Discussion Paper no 8; World Health Organization
  7. State Department of Statistics: Medical service in Georgia: Survey report on population's health-care expenses and unrecorded medical service. 2000, Tbilisi: State Department of Statistics of Georgia

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Metadata

Authors
Gotsadze, G., Zoidze, A., & Rukhadze, N.
Affiliations
Curatio International Foundation (GE)
Corresponding author
Rukhadze, Natia
ORCID
Gotsadze, George
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2009-04-28
Volume
9
Issue
1
Pages
69-69
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/1472-6963-9-69
PMC
PMC2695816
OpenAlex
W2051202685
Cited by
169
References
19
Citations by year
2026: 2 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 15 · 2021: 17 · 2020: 14 · 2019: 15 · 2018: 11 · 2017: 10 · 2016: 9 · 2015: 11 · 2014: 24 · 2013: 9 · 2012: 5
FWCI
8.46
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
Keywords
catastrophic health expenditure, household health expenditure, health financing reform, out-of-pocket costs, financial protection, poverty, chronic disease, hospitalization, drug benefits, Georgia
MeSH terms
Catastrophic Illness, Health Expenditures, Family Characteristics, Georgia (Republic), Health Services, Health Services Accessibility, Health Services Research, Health Surveys, Humans, Poverty Areas, Surveys and Questionnaires, Logistic Models, Health Care Reform

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