Knaul,

1
Taller de consulta sobre Medición de la Calidad
de VidaSALUD QUE SABEMOS, QUE MÁS DEBERÍAMOS
DE SABER Y COMO PODEMOS AVERIGUARLO
Knaul, 8 de diciembre del 2006
2
CATASTROPHIC AND IMPOVERISHING HEALTH SPENDING
A GLOBAL PROBLEM

• LAC high rates and increasingly important
  challenge for families as demographic and
  epidemiological transitions proceed
• Asia Van Doorslaer et al
• An additional seventy-eight million people or
  2.7 of the total population, fall below the
  extreme poverty threshold of 1 per day after
  accounting for payments for health care. (11
  COUNTRIES, 79 of the Asian population),
• This represents a 14 increase in the rate of
  extreme poverty.
• USA, Himmelstein, HEALTH AFFAIRS, 2005.
• Medical problems contributed to 50 of all
  bankruptcy files
• Globally, every year (WHO)
• 44 million households face catastrophic
  expenditure
• 25 million households are pushed into poverty by
  the need to pay for services.
• ANNUAL, GLOBAL ESTIMATE MAY BE ?4? TIMES HIGHER

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MEXICO 2000(PRE-REFORM) THE INCIDENCE OF
ABSOLUTE AND RELATIVE IMPOVERISHMENT FROM HEALTH
SPENDING IS HIGH, PARTICULARLY AMONG THE
UNINSURED AND THE POOR.
3.4
Relative (more than 30 of disposable income)
Absolute (pushed below poverty line or
deeper into poverty)
3.8
Absolute and/or relative
6.3,
1.5 million families per trimester 4
million per year
Insured
2.2
9.6
Uninsured
Poorest quintile, 910,000 families per trimester
19.6
Quintiles 2,3,4 and 5
3.1
In the poorest quintile, 2/3 of families are
below the poverty line and spend less than 30 of
disposable income, and 22 cross the poverty line
due to health spending.
30, 20 etc
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AMONG POOR HOUSEHOLDS, IMPOVERISHING HEALTH
EXPENDITURE IS CONCENTRATED IN MEDICINES AND
AMBULATORY CARE AMONG THE RICH, IN
HOSPITALIZATION
Medicines
Maternity
Hospitalization
Other
Ambulatory care
poor
II
III
IV
wealthy
Source Authors calculations based on ENIGH,
2000.
5
THE HIGHEST RATES OF RELATIVE AND ABSOLUTE
IMPOVERISHMENT FROM HEALTH SPENDING ARE AMONG
FAMILIES WITH OLDER ADULTS AND YOUNG CHILDREN,
AND SINCE 2000 PARTICULARLY AMONG FAMILIES WITH
OLDER ADULTS
of households with relative and/or absolute
impoverishment
Older adults and children
30
Children, no older adults
of households
older adults, no children
Neither children or older adults
5
0
1992
1994
1996
1998
2000
2002
2004
Source Knaul F, Arreola H, Mendez O. Tendencias
en la protección financiera en salud en México.
México, D. F. FUNSALUD,documento de trabajo,
2005.
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Health (care) or impoverishment

• Single mother earning 2 m.s. on Oaxaca, both
  children develop a throat infection doctor
  visits and antibiotics gt30 of disposable income
• 6-person family in Veracruz, below poverty line,
  agricultural worker
• grandmother-Type II diabetes
• Child with cancer

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How do families finance health events? often by
reducing investment in other basic needs and
human capital, 2001
Source Authors calculations based on ENAGS,
2001.
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Future research

• How can measurement and definition issues be
  improved?
• What are the determinants of excessive,
  catastrophic and impoverishing health expenditure
  among families?
• What is the effect on poverty, human capital and
  family well-being (eg. Gertler and Gruber) at the
  micro level and, on firms, labor markets, growth
  and competitiveness at the macro level?
• Is there impact/a causal relationship between the
  changes in fairness of finance and the efforts to
  achieve financial protection that are proposed in
  reforms and policies?

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Methodological and data-related challenges

• Explaining and correcting variation across
  surveys
• health spending, total spending and family income
• Defining periodicity and the timeframe of
  impoverishment
• Once per year number of times per year
• Once per week, month, trimester
• Measuring changes over time longitudinal data
• Expanding and improving concepts and
  methodologies
• measurement of disposable income
• objectively defining catastrophic and deepening
  impoverishment
• Incorporating income losses due to ill health
• Studies of impact
• Other indices

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More, and more general requirements

• Registry and bank of health and health
  establishment surveys for LAC especially older
  surveys
• Standardized questionnaires (similiar to LFP)
• Link health surveys to other data bases
• Calidad de Vida
• Encuestas de Ingreso y Gasto de los Hogares
• Links to administrative data

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Taller de consulta sobre Medición de la Calidad
de VidaSALUD QUE SABEMOS, QUE MÁS DEBERÍAMOS
DE SABER Y COMO PODEMOS AVERIGUARLO
Knaul, 8 de diciembre del 2006