BackgroundOut-of-pocket expenditure to pay for health services could result in financial catastrophe. The purpose of this study was to identify the incidence and determinants of catastrophic out-of-pocket payments for healthcare in Colombia. The underlying hypotheses are that low-income and non-insured population in Colombia, and households living in isolated and high level of rurality regions, are more likely to incur catastrophic healthcare expenses.MethodsThis study used data from the Quality of Life National Survey conducted in Colombia in 2011. The presence of catastrophic healthcare spending was calculated using the methodology proposed by the World Health Organization in 2005. Households were classified as having catastrophic health spending when their out-of-pocket health payments were over 20 % of their payment capacity. All other households were classified as not having catastrophic health spending. A probit model was estimated aimed at determining what factors influence the probability of catastrophic healthcare spending.ResultsStudy findings show that 9.6 % of Colombian households had catastrophic expenditure. The incidence was higher in households in the Pacífica and Atlántica regions, extended and nuclear families, households with children or elderly adults, located in rural areas, and not insured under the healthcare system. The ratio of household members who work seems to reduce the risk of catastrophic healthcare spending, but the occurrence of any in-patient event increases it. So, there is no statistical evidence for rejecting the hypotheses under study.ConclusionsResults indicate the importance of establishing intervention mechanisms in order to improve equity in access and payment for health care, protect vulnerable groups against financial risk, and, consequently, reduce the incidence of catastrophic healthcare spending. For this, it is essential to achieve universal health coverage through standardized and improved health services packages for vulnerable age groups and implement healthcare campaigns for households in rural areas where the incidence of out-of-pocket payments is higher.

The new methodology applying for burden of disease study (GBD 2010) is difficult to completely reproduce in Colombia. This paper presents the results of partial use of this methodology to estimate the components years lost due to premature death (YLLs) and lived with disability (YLDs). Redistribution of useless codes produces significant increases in some causes of death, which are preferable to deal with an analysis of causes of death with 15,6 % of useless codes that would provide little or no statistical information. Ischemic heart disease, cerebrovascular and hypertensive heart disease events cause the highest risk of mortality rate (164,2 per 100,000). Assaults by firearms and sharp objects, self-inflicted injuries and those caused by motorcycles and four-wheeled vehicles on the road, are the first cause of YLLs per 1000 (34,3). Skin diseases such as dermatitis, erythemas, burns on exposure to sunlight, pediculosis and pityriasis, cause the greatest risk of YLDs per 1000 (51,3). This group of skin diseases are also the leading cause of DALYs per 1000 (51,4). The departments with the highest rates of mortality and YLLs for Group I (communicable diseases) are Guainía, Amazonas, Vaupés, Cauca, Vichada, Putumayo, Nariño, Chocó, Cordoba, La Guajira, Guaviare y Caquetá and with the lower mortality coverage.

The negative impact of health‐related out‐of‐pocket (OOP) payments is a well‐known problem in low and middle‐income countries (LMICs). Cross‐sectional analysis reveals that households use different coping mechanisms to mitigate or overcome the effect of OOP payments, but little is known from a longitudinal perspective. We explore this link using panel data for Colombia, Mexico, India, Malawi, Nigeria, Uganda, and Tanzania. Using a fixed‐effect model, we computed the association between multidimensional poverty (MP) and facing catastrophic health payments (CHP) using a capacity‐to‐pay approach. We estimated different heterogeneous effects, including variables such as area of residence, facing CHP, being poor in the first wave, and facing CHP in period two. While using cross‐sectional data, we found that the association between CHP and MP is present for six of the seven countries; it is not the case for the time variation in most of them. The results provide evidence that OOP induce a long‐term impact on MP only in Colombia, India and Nigeria. In the last two countries, the levels of poverty and CHP were the highest of all seven, and the association between both situations was found by using different poverty cutoffs and thresholds to define CHP.

Objetivo: comparar el nivel de implementación del Modelo de Vigilancia de la Morbilidad Materna Extrema (MVMME) y las principales barreras y facilitadores respecto de la implementación en dos grupos de instituciones prestadoras de servicios de salud (IPS) de Colombia.<p>Materiales y métodos: estudio mixto, que emplea técnicas de información cuantitativa (instrumento semiestructurado) y cualitativa (entrevista a profundidad). Las IPS en las que se inició el modelo piloto (IPSP) fueron comparadas con otro grupo de IPS que no participó en la inserción inicial del mismo, las que se denominarán IPS control (IPSC). Ambas fueron seleccionadas por conveniencia en conjunto con el Ministerio de Salud. El nivel de implementación se presenta como proporción por institución. La información se trianguló para complementar la información de los diferentes componentes de la implementación del MVMME.</p><p>Resultados: hubo diferencias en la implementación según el grupo de IPS, en IPSP hubo mayor difusión de protocolos, detección, notificación, flujo de la información, análisis y toma de decisiones. En IPSC hubo más dificultades con la asignación de la causa principal, definir criterios de evitabilidad e identificar demoras. El volumen de profesionales, las horas promedio mes y los perfiles eran mayores en IPSP que en IPSC. El rango del nivel de implementación entre las IPSP varió entre el 73 y el 94 %; en el grupo de IPSC el rango estuvo entre 41 y 90 %. En las IPSP había mayor claridad sobre el papel del MVMME como herramienta para mejorar la calidad en la atención de las gestantes. En IPSC, si bien consideraban que el modelo ayudaba a mejorar la calidad, era interpretado como una sobrecarga de trabajo.</p><p>Conclusiones: el mayor desarrollo en IPSP podría estar asociado a un mayor acompañamiento por parte del MS-UNFPA, y una mayor voluntad política e institucional para su implementación.</p>