Disaggregating catastrophic health expenditure by disease area: cross-country estimates based on the World Health Surveys

Abstract

BackgroundFinancial risk protection (FRP) is a key objective of national health systems and a core pillar of universal health coverage (UHC). Yet, little is known about the disease-specific distribution of catastrophic health expenditure (CHE) at the national level.MethodsUsing the World Health Surveys (WHS) from 39 countries, we quantified CHE, or household health spending that surpasses 40% of capacity-to-pay by key disease areas. We restricted our analysis to households in which the respondent used health care in the last 30 days and categorized CHE into disease areas included as WHS response options: maternal and child health (MCH); high fever, severe diarrhea, or cough; heart disease; asthma; injury; surgery; and other. We compared disease-specific CHE estimates by income, pooled funding as a share of total health expenditure, share of the population affected by the different diseases, and poverty status.ResultsAcross countries, an average of 45.1% of CHE cases could not be tied to a specific cause; 37.6% (95% UI 35.4–39.9%) of CHE cases were associated with high fever, severe cough, or diarrhea; 3.9% (3.0–4.9%) with MCH; and 4.1% (3.3–4.9%) with heart disease. Injuries constituted 5.2% (4.2–6.4%) of CHE cases. The distribution of CHE varied substantially by national income. A 10% increase in heart disease prevalence was associated with a 1.9% (1.3–2.4%) increase in heart disease CHE, an association stronger than any other disease area.ConclusionsOur approach is comparable, comprehensive, and empirically based and highlights how financial risk protection may not be aligned with disease burden. Disease-specific CHE estimates can illuminate how health systems can target reform to best protect households from financial risk.Electronic supplementary materialThe online version of this article (10.1186/s12916-019-1266-0) contains supplementary material, which is available to authorized users.

The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion

“…A modelling study to quantify the magnitude CHE among the poorest billion was done ( appendix p 102 ). 198 Corroborating evidence regarding the effect of NCDIs on CHE and household impoverishment from National NCDI Poverty Commissions that had carried out country-level studies was sought.

Voices of NCDI Poverty Pabitra Manandhar, chronic kidney disease, 26 years old (Nepal) * “Life used to be good.

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Toward universal health coverage in the post-COVID-19 era

“…For FRP, direct medical costs for health services, including OOP payments for inpatient or outpatient care, are typical markers. Based on these OOP inputs, estimates of cases of catastrophic expenditures (OOP costs surpassing a certain threshold of household expenditures or income) and impoverishing expenditures (OOP costs pushing households under a defined poverty line) can be computed 12,[27][28][29] .…”

Trends in out of pocket payments and catastrophic health expenditure in the Kyrgyz Republic post “Manas Taalimi” and “Den Sooluk” health reforms, 2012–2018

“…The financial protection argument stems from existing and overwhelming evidence of the catastrophic nature of direct healthcare payments in the form of OOPPs at the point of use [5][6][7][8]. Since health and healthcare are considered human rights and the demand for healthcare is largely inelastic to price fluctuations [9], households employ numerous strategies to finance healthcare and cope with the economic hardship resulting from healthcare expenditures [10,11].…”