Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017

Abstract

Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. Methods: We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. Results: The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). Conclusions: Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature

“…The results from examining the protective effect of different health insurance schemes (Additional file 7) suggest that health insurance in LMICs did not consistently offer a higher degree of FRP. Even though insurance lowered CHE in six studies (in Ghana, Iran, Peru, Thailand and Viet Nam) [34,[52][53][54][55][56], three studies reported higher CHE in India, Iran and Kenya [57][58][59], and another three studies reported not necessarily lower CHE in Colombia, Mexico and Vietnam [60][61][62]. Again, two of these studies showed mixed results: insured households incurred higher CHE but lower impoverishment than the noninsured in India [57], and CHE decreased but impoverishment increased just after launching the Health Transformation Plan in Iran [56].…”

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019

“…When designing and implementing financing protection policies, it is crucial to consider demographics, vulnerable groups, and diseases that exhibit higher likelihoods of CHE [ 8 , 28 , 32 ]. In addition to the effort to decrease the occurrence of CHE, there is a need to reduce socioeconomic inequality concerning the burden of CHE among various subpopulations by ensuring comprehensive coverage for all and facilitating access to health resources and services [ 33 ]. Based on the findings of this study, living in an urban area, having a higher wealth in-dex, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of experiencing CHE.…”

Informal payments in health facilities in Peru in 2018: analysis of a cross-sectional survey

“…In that sense, it may be valid to assume that all transactions where patients report being not given any information about official co-payments rates or fees are informal. (21) (5) (22) Future efforts to measure informal payments may consider assessment of respondents’ awareness of entitlements and expected payments.…”