Protecting households from catastrophic health spending

Health Affairs

Volumn 26, Issue 4, 2007, Pages 972-983

  Xu, Ke ^a   Evans, David B ^b   Carrin, Guido ^b   Aguilar Rivera, Ana Mylena ^b,c   Musgrove, Philip ^b   Evans, Timothy ^d  

^a WORLD HEALTH ORGANIZATION   (Switzerland)

^b Department of Health Systems Financing ^*

^c HARVARD UNIVERSITY   (United States)

^d WHO

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST OF ILLNESS; CULTURAL FACTOR; DEVELOPED COUNTRY; DEVELOPING COUNTRY; ECONOMICS; FAMILY SIZE; FINANCIAL MANAGEMENT; HEALTH CARE COST; HEALTH CARE DELIVERY; HUMAN; INCOME; POVERTY; PUBLIC HEALTH; REGRESSION ANALYSIS; STANDARD; STATISTICS; TERMINAL DISEASE;

CATASTROPHIC ILLNESS; COST OF ILLNESS; CROSS-CULTURAL COMPARISON; DELIVERY OF HEALTH CARE; DEVELOPED COUNTRIES; DEVELOPING COUNTRIES; FAMILY CHARACTERISTICS; FINANCING, GOVERNMENT; FINANCING, PERSONAL; HEALTH EXPENDITURES; HEALTH SERVICES ACCESSIBILITY; HUMANS; INCOME; NATIONAL HEALTH PROGRAMS; POVERTY; REGRESSION ANALYSIS;

EID: 34548329324     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.4.972     Document Type: Article

References (37)

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4. K. Xu et al., "Household Catastrophic Health Expenditure: A Multicountry Analysis," Lancet 362, no. 9378 (2003): 111-117;
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11. Previous thresholds vary from 5 percent to 20 percent of total income - or 12.5-50 percent of nonsubsistence income for poor families spending 60 percent of their income on food. The rank-order correlation coefficient of the proportion of households with catastrophic spending ranges from 0.95 to 0.99 across countries, using thresholds set at 30 percent, 40 percent, and 50 percent of household capacity to pay. S.E. Berki, "A Look at Catastrophic Medical Expenses and the Poor," Health Affairs 5, no. 4 (1986): 138-145;
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14. Xu et al., "Household Catastrophic Health Expenditure."
15. While permanent income might be reflected in the assets a household owns, many surveys did not provide enough information to develop an asset index and value assets in money terms - needed for the denominator in this analysis. C.J.L. Murray et al., "Assessing the Distribution of Household Financial Contributions to the Health System: Concepts and Empirical Application," in Health Systems Performance Assessment: Debates, Methods, and Empiricism, ed. C.J.L. Murray and D.B. Evans (Geneva: WHO, 2003), 513-531;
16. and K. Xu et al., "Household Health System Contributions and Capacity to Pay: Definitional, Empirical, and Technical Challenges," in Health Systems Performance Assessment, ed. Murray and Evans, 533-542
17. Xu et al., "Household Health System Contributions."
18. Full details are reported in Xu et al., "Household Catastrophic Health Expenditure";
19. Murray et al., "Assessing the Distribution";
20. and K. Xu et al., "Distribution of Health Payments and Catastrophic Expenditures - Methodology," Health Systems Financing Discussion Paper no. 2 (Geneva: WHO, 2005).
21. The Gini coefficient is a summary measure of inequality, usually applied to the distribution of income or spending across households or individuals. It ranges from 0 to 1, with 0 representing total equality and 1 representing the other extreme. For the list of countries, type of survey, and survey years, see online Appendix 1 at http://content.healthaffairs.org/cgi/content/full/26/4/972/ DC1.
22. For the regression analysis, all continuous variables were transformed into natural logarithms for estimation. For most countries, only one household expenditure survey was available. However, the database included four surveys for one country, three surveys for six countries, and two surveys for twelve countries. Accordingly, not all data points can be assumed to be independent, so the robust cluster option in STATA was used to account for clustering. The regressions reported in Exhibit 4 had a good statistical fit. The variance inflation indicators (VIF) indicate that there are no problems with multicollinearity (VIF < 2.6 for all covariates).
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24. K. Xu et al., "Understanding the Impact of Eliminating User Fees: Utilization and Catastrophic Health Expenditures in Uganda," Social Science and Medicine 62, no. 4 (2006): 866-876;
25. and E. Cavagnero et al., "Health Financing in Argentina: An Empirical Study of Health Care Utilization and Health Care Expenditure," Health Financing Policy Discussion Paper no. 5 (Geneva: WHO, 2006).
26. General government spending is the denominator because social health insurance spending is included in government health expenditures reported in the WHO National Health Accounts, the source of our data.
27. Xu et al., "Household Catastrophic Health Expenditure."
28. The proportion of the population living in poverty could have been used as an alternative to the Gini coefficient. It would be more appropriate for identifying the determinants of impoverishment rather than financial catastrophe, which can occur to people at all income levels.
29. WHO, World Health Report 2006 (Geneva: WHO, 2006).
30. Details are provided in online Appendix 1, as in Note 11.
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35. WHO, Macroeconomics and Health: Investing in Health for Economic Development (Geneva: WHO, 2001).
36. K. Xu et al., "The Impact of Vertical and Horizontal Inequality on the Fairness in Financial Contribution Index," in Health Systems Performance Assessment, ed. Murray and Evans, 557-563.
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