Out-of-Pocket Expenditures on Health: A Global Stocktake

Wagstaff, Adam; Eozenou, Patrick; Smitz, Marc-François

doi:10.1093/wbro/lkz009

Cited by 73 publications

(62 citation statements)

References 25 publications

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“…One major issue in earlier out-of-pocket healthcare spending–poverty research concerned the reliance on the variation between specific poverty measures before and after out-of-pocket health expenses were included in total household consumption; as a primary empirical approach, see Wagstaff et al [ 8 ]. Therefore, the previous literature on the impoverishing effects of out-of-pocket health spending has depended predominantly on survey-based or micro-level data of a specific country [ 11 ]. To date, however, few studies have investigated the association between out-of-pocket health expenditure and poverty using aggregated macro-level data [ 11 ], which is useful for providing cross-country analysis.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the previous literature on the impoverishing effects of out-of-pocket health spending has depended predominantly on survey-based or micro-level data of a specific country [ 11 ]. To date, however, few studies have investigated the association between out-of-pocket health expenditure and poverty using aggregated macro-level data [ 11 ], which is useful for providing cross-country analysis. It has also been argued that some households may spend up to a certain threshold of their budget (10% or 25%) on health care without affecting the resources left over to sustain their basic needs [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Out-of-Pocket Health Expenditure and Poverty: Evidence from a Dynamic Panel Threshold Analysis

Sirag

Nor

2021

Healthcare

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The current study investigated the association between out-of-pocket health expenditure and poverty using macroeconomic data from a sample of 145 countries from 2000 to 2017. In particular, it was examined whether the relationship between out-of-pocket health expenditure and poverty was contingent on a certain threshold level of out-of-pocket health spending. The dynamic panel threshold method, which allows for the endogeneity of the threshold regressor (out-of-pocket health expenditure), was used. Three indicators were adopted as poverty measures, namely the poverty headcount ratio, the poverty gap index, and the poverty gap squared index. At the same time, out-of-pocket health expenditure was measured as a percentage of total health expenditure. The results showed the validity of the estimated threshold models, indicating that only beyond the turning point, which was about 29 percent, that out-of-pocket health spending led to increased poverty. When heterogeneity was controlled for in the sample, using the World Bank income classification, the findings showed variations in the estimated threshold, with higher values for the low- and lower-middle-income groups, as compared to the high-income group. For the lower-income groups, below the threshold for out-of-pocket health expenditure, it had a positive or insignificant effect on poverty reduction, while it led to higher poverty above the threshold. Further, the sampled countries were divided into regions, according to the World Health Organization. Generally, improving health care systems through tolerable levels of out-of-pocket health expenditure is an inevitable step toward better health coverage and poverty reduction in many developing countries.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Out-of-Pocket Health Expenditure and Poverty: Evidence from a Dynamic Panel Threshold Analysis

Sirag

Nor

2021

Healthcare

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“…What may differ greatly between countries is the proportion of the population and sub‐groups within it who are vulnerable to financial burden and the degree of impact financial burden may have on these populations. Levels of poverty are greater in LMICs, 92 and people in LMICs are more vulnerable to impoverishment due to OOP payments 18 …”

Section: Discussionmentioning

confidence: 99%

“…A systematic review 17 concludes that financial catastrophe due to non‐communicable diseases is evident across all continents and across all income strata. However, citizens of LMICs are more vulnerable to impoverishment due to OOP payments 18 …”

Section: Introductionmentioning

confidence: 99%

The experience of financial burden for people with multimorbidity: A systematic review of qualitative research

Larkin

Foley

Smith

et al. 2020

Health Expectations

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Background Multimorbidity prevalence is increasing globally. People with multimorbidity have higher health care costs, which can create a financial burden. Objective To synthesize qualitative research exploring experience of financial burden for people with multimorbidity. Search strategy Six databases were searched in May 2019. A grey literature search and backward and forward citation checking were also conducted. Inclusion criteria Studies were included if they used a qualitative design, conducted primary data collection, included references to financial burden and had at least one community‐dwelling adult participant with two or more chronic conditions. Data extraction and synthesis Screening and critical appraisal were conducted by two reviewers independently. One reviewer extracted data from the results section; this was checked by a second reviewer. GRADE‐CERQual was used to summarize the certainty of the evidence. Data were analysed using thematic synthesis. Main results Forty‐six studies from six continents were included. Four themes were generated: the high costs people with multimorbidity experience, the coping strategies they use to manage these costs, and the negative effect of both these on their well‐being. Health insurance and government supports determine the manageability and level of costs experienced. Discussion Financial burden has a negative effect on people with multimorbidity. Continuity of care and an awareness of the impact of financial burden of multimorbidity amongst policymakers and health care providers may partially address the issue. Patient or public contribution Results were presented to a panel of people with multimorbidity to check whether the language and themes ‘resonated’ with their experiences.

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“…6 Furthermore, the median year that data was calculated was 2005, which may be too old to provide a meaningful benchmark to begin to monitor progress toward the SDGs. Although a more updated version of the same database was recently released, 56 which was able to identify data from at least a dozen or so more countries, the overall picture, especially over time, remains highly incomplete. Additional data collection efforts are likely necessary in order to provide a more complete picture of FP and to be able to adequately track progress going forward.…”

Section: Data Availabilitymentioning

confidence: 99%

On the Measurement of Financial Protection: An Assessment of the Usefulness of the Catastrophic Health Expenditure Indicator to Monitor Progress Towards Universal Health Coverage

Grépin

Irwin

Trakinsky

2020

Health Systems & Reform

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Ensuring financial protection (FP) against health expenditures is a key component of Sustainable Development Goal (SDG) 3.8, which aims to achieve Universal Health Coverage (UHC). While the proportion of households with catastrophic health expenditures exceeding a proportion of their total income or consumption has been adopted as the official SDG indicator, other approaches exist and it is unclear how useful the official indicator is in tracking progress toward the FP subtarget across countries and across time. This paper evaluates the usefulness of the official SDG indicator to measure FP using the RACER framework and discusses how alternative indicators may improve upon the limitations of the official SDG indicator for global monitoring purposes. We find that while all FP indicators have some disadvantages, the official SDG indicator has some properties that severely limit its usefulness for global monitoring purposes. We recommend more research to understand how alternative indicators may enhance global monitoring, as well as improvements to the quality and quantity of underlying data to construct FP indicators in order to improve efforts to monitor progress toward UHC.

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Out-of-Pocket Expenditures on Health: A Global Stocktake

Cited by 73 publications

References 25 publications

Out-of-Pocket Health Expenditure and Poverty: Evidence from a Dynamic Panel Threshold Analysis

Out-of-Pocket Health Expenditure and Poverty: Evidence from a Dynamic Panel Threshold Analysis

The experience of financial burden for people with multimorbidity: A systematic review of qualitative research

On the Measurement of Financial Protection: An Assessment of the Usefulness of the Catastrophic Health Expenditure Indicator to Monitor Progress Towards Universal Health Coverage

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