Understanding Household Catastrophic Health Expenditure

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Understanding Household Catastrophic Health
Expenditure
Ke Xu, A M Aguilar-Rivera, David B Evans Health
System Financing, Expenditure and Resource
Allocation
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Distribution of household financial contribution
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Catastrophic Health Expenditure Out-of-pocket
health expenditures is equal to or more than 40
of household non-subsistence spending

• Reduce other basic expenses
• Push some households into poverty
• Forgo health services and suffer illness

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

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Within country studies

• e.g. Indonesia SUSENAS (1999 2000 2001)

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Catastrophic Health Expenditure, Impoverishment
and not seeking care
Catastrophic
Impoverishment
Not seeking care
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Utilization of Health Servicesby Expenditure
Deciles
1999
2001
Source Susenas 1999 and 2001. Core
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Percentage of Households at Different Levels of
Health Spending
Source Susenas 1999, 2000 and 2001. Core
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Socio-economic Factors of Households Related to
Catastrophic Expenditures (2001)
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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

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Spare slides
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Methodology

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

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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)

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determinants of catastrophic health expenditure
from cross country analysis