Catastrophic Health Expenditures in Latin America: A Multi-National Analysis of Social Protection

Presenter: Martin Valdivia, GRADE

Abstract

Objectives: To compare the prevalence of households with catastrophic health spending reported in seven Latin American Countries, and contrast the populations sub-groups that are more prone to suffer these expenses. Material and Methods: We estimated indicators of the prevalence of catastrophic health expenditures uniformly for seven countries using household surveys in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico and Peru. We calculated percentages of catastrophic expenditures and confidence intervals using a variety of indicators originally developed by WHO and by Wagstaff and Van Doorslaer. We used ratios to compare the level of relative catastrophic expenditures by sub-groups of the populations defined by economic variables (such as quintiles of expenditure, urban or rural residence) and social (such as availability of health insurance, household size, household composition). In order to achieve comparability between countries, these ratios were standardized by country. It is also important to highlight that the results are analyzed as a function of the particularities of each health system in terms of the organization of social insurance and financial protection in health. Results: The prevalence with catastrophic spending varies from 1 to 25% in the seven countries, which highlights to the heterogeneity in social protection across the countries in the study. In general, rural households have a higher propensity to have catastrophic spending than urban. Catastrophic and impoverishing health spending tends to be more common in the lowest-income quintiles in households that include elderly persons. These results vary somewhat across countries. The discussion seeks to link the results to the social and health programs and other characteristics of the countries studied. The discussion seeks to link the results to the social and health programs and other characteristics of the countries studied. It is anticipated that results from Bolivia and Dominican Republic will also be incorporated into the results by July 2009, making for a total of 9 regional countries.