Transcript No Slide Title

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
Evidence and Information for Policy
1
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%
Evidence and Information for Policy
2
Catastrophic Expenditure and Impoverishment
VNM
5
% of impoverish households
4
BRA
3
COL
BGD
GHA
KHM
2
BGR
JAM
NIC
1
SEN
KGZ
MAR
EST
PAN
YEM
0
0
LBN
PER
ZMB PRT
MEX
PHL MUS
GUY
THA
LTU
NAM
HRV
ROM
DJI
HUNUSA
CRI
ZAF
ISR
SVK
ESP
CZE
FRA
DEU
GBR
SVN
DNK
CAN
BEL
SWE
NOR
ISL
FIN
CHE
UKR
PRY
EGY
LVA
LKA
IDN
AZE
ARG
KOR GRC
2
4
6
8
10
% of catastrophic households
Evidence and Information for Policy
3
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)
Evidence and Information for Policy
4
Proportion of Households with Catastrophic Expenditures vs. Share of
Out-of-pocket Payment in Total Health Expenditures (OOP%THE)
13.5
VNM
BRA
LBN
4.9
due to out-of-pocket payments (logarithm)
% of households with catastrophic expenditures
AZE
COL
ARG
UKR
KHM
PRY
PER
EGY
LVA
PRT
PAN
NIC
JAM
1.8
ZMB
GRC
BGR
KOR
YEM
MEX
LTU
GHA
MUS
LKA
BGD
THA
.70
ESP
.30
HRV
CRI
SEN
FIN
EST
ISL
NOR
PHL
KGZ
GUY
USA
CHE
IDN
ISR
DJI
HUN
SWE
MAR
NAM
CAN
ROM
.09
SVN
BEL
DNK
GBR
.03
ZAF
DEU
.01
FRA
3.0
5.0
8.0
14.0
22.0
37.0
61.0
,
OOP%THE (logarithm)
Evidence and Information for Policy
5
100
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.
Evidence and Information for Policy
6
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?
Evidence and Information for Policy
7
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
Evidence and Information for Policy
8