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Cited by 32Healthcare Systems and ReformsEconomic and Financial Impacts of CancerHealthcare Policy and Management

Evolution of catastrophic health expenditure in a high income country: incidence versus inequalities

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Quintal, Carlota·2019·International Journal for Equity in Health
DOI 10.1186/s12939-019-1044-9PMC PMC6749702
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Abstract

Background: Catastrophic health expenditure (CHE) is well established as an indicator of financial protection on which there is extensive literature. However, most works analyse mainly low to middle income countries and do not address the different distributional dimensions of CHE. We argue that, besides incidence, the latter are crucial to better grasp the scope and nature of financial protection problems. Our objectives are therefore to analyse the evolution of CHE in a high income country, considering both its incidence and distribution. Methods: Data are taken from the last three waves of the Portuguese Household Budget Survey conducted in 2005/2006, 2010/2011 and 2015/2016. To identify CHE, the approach adopted is capacity to pay/normative food spending, at the 40% threshold. To analyse distribution, concentration curves and indices (CI) are used and adjusted odds ratios are calculated. Results: The incidence of CHE was 2.57, 1.79 and 0.46%, in 2005, 2010 and 2015, respectively. CHE became highly concentrated among the poorest (the respective CI evolved from − 0.390 in 2005 to − 0.758 in 2015) and among families with elderly people (the absolute CI evolved from 0.520 in 2005 to 0.740 in 2015). Absolute CI in geographical context also increased over time (0.354 in 2015, 0.019 in 2005). Medicines represented by far the largest share of catastrophic payments, although, in this case concentration decreased (the median share of medicines diminished from 93 to 43% over the period analysed). Contrarily, the weight of expenses incurred with consultation fees has been growing (even for General Practitioners, despite the NHS coverage of primary care). Conclusions: The incidence of CHE and inequality in its distribution might progress in the same direction or not, but most importantly policy makers should pay attention to the distributional dimensions of CHE as these might provide useful insight to target households at risk. Greater concentration of CHE can actually be regarded as an opportunity for policy making, because interventions to tackle CHE become more confined. Monitoring the distribution of payments across services can also contribute to early detection of emerging (and even, unexpected) drivers of catastrophic payments.

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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 [142]

    The Results (Table 1) report catastrophic health expenditure incidence in Portugal, a European country, falling from 2.57% in 2005/06 to 0.46% in 2015/16. The paper does not compare those rates with sub-Saharan Africa or establish a Europe-wide comparison. Its Methods use a 40%-of-capacity-to-pay definition, while the Discussion proposes testing other definitions in future work, so it does not support the claim that the comparison holds irrespective of definition. (LLM, conf=0.83)

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Authors
Quintal, C.
Affiliations
University of Coimbra (PT)
Corresponding author
Quintal, Carlota
ORCID
Quintal, Carlota
Venue
International Journal for Equity in Health
Publisher
Springer Science and Business Media LLC
Published
2019-09-18
Volume
18
Issue
1
Pages
145-145
ISSN
1475-9276 (ISSN-L)
DOI
10.1186/s12939-019-1044-9
PMC
PMC6749702
OpenAlex
W2974449718
Cited by
31
References
39
Citations by year
2026: 4 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 4 · 2021: 3 · 2020: 1 · 2012: 1
FWCI
2.42
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal for Equity in Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › 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 › Healthcare Policy and Management
Keywords
catastrophic health expenditure, financial protection, health disparities, concentration index, household health expenditure, consultation fees, elderly households, regional disparities, Portugal, high-income countries
MeSH terms
Catastrophic Illness, Health Expenditures, Humans, Portugal, Socioeconomic Factors, Incidence

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