2018-02-06
Progress on catastrophic health spending in 133 countries: a retrospective observational study
Publication
Publication
The Lancet Global Health , Volume 6 - Issue 2 p. e169- e179
Background The goal of universal health coverage (UHC) requires inter alia that families who get needed health
care do not suffer undue financial hardship as a result. This can be measured by the percentage of people in
households whose out-of-pocket health expenditures are large relative to their income or consumption. We aimed
to estimate the global incidence of catastrophic health spending, trends between 2000 and 2010, and associations
between catastrophic health spending and macroeconomic and health system variables at the country level.
Methods We did a retrospective observational study of health spending using data obtained from household
surveys. Of 1566 potentially suitable household surveys, 553 passed quality checks, covering 133 countries between
1984 and 2015. We defined health spending as catastrophic when it exceeded 10% or 25% of household consumption.
We estimated global incidence by aggregating up from every country, using a survey for the year in question when
available, and interpolation and model-based estimates otherwise. We used multiple regression to explore the relation
between a country’s incidence of catastrophic spending and gross domestic product (GDP) per person, the Gini
coefficient for income inequality, and the share of total health expenditure spent by social security funds, other
government agencies, private insurance schemes, and non-profit institutions.
Findings The global incidence of catastrophic spending at the 10% threshold was estimated as 9·7% in 2000, 11·4% in
2005, and 11·7% in 2010. Globally, 808 million people in 2010 incurred catastrophic health spending. Across
94 countries with two or more survey datapoints, the population-weighted median annual rate of change of
catastrophic payment incidence was positive whatever catastrophic payment incidence measure was used. Incidence
of catastrophic payments was correlated positively with GDP per person and the share of GDP spent on health, and
incidence correlated negatively with the share of total health spending channelled through social security funds and
other government agencies.
Interpretation The proportion of the population that is supposed to be covered by health insurance schemes or by
national or subnational health services is a poor indicator of financial protection. Increasing the share of GDP spent
on health is not sufficient to reduce catastrophic payment incidence; rather, what is required is increasing the share
of total health expenditure that is prepaid, particularly through taxes and mandatory contributions.
Additional Metadata | |
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Funding: Rockefeller Foundation, Ministry of Health of Japan, UK Department for International Development (DFID) | |
doi.org/10.1016/S2214-109X(17)30429-1, hdl.handle.net/1765/104107 | |
The Lancet Global Health | |
Organisation | Erasmus School of Health Policy & Management (ESHPM) |
Wagstaff, A., Flores, G., Hsu, J., Smitz, M.-F., Chepynoga, K., Buisman, L., … Hoang-Vu Eozenou, P. (2018). Progress on catastrophic health spending in 133 countries: a retrospective observational study. The Lancet Global Health, 6(2), e169–e179. doi:10.1016/S2214-109X(17)30429-1 |