Stimulated by the work of the ECuity research network in Europe and Equitap in Asia, the past decade has seen the development and adoption across the world of standard tools for examining the catastrophic impact of health expenditures across households and across countries. This session brings together for the first time some of the latest research in this area from the USA, Latin America, Africa and Asia. All the papers present findings on the level of catastrophic expenditures in different countries, measured using comparable methods, and how these are distributed across households at different income levels, and of varying socioeconomic and health plan coverage characteristics. The US paper also uses the unique MEPS data to show that the length of the reference period, which has frequently been identified as a parameter than undermines the comparability of results from different studies, is not as significant a problem for comparability as often thought. All the papers also look at how the level and distribution of catastrophic expenditures is related to coverage by insurance and other risk protection schemes. Whilst demonstrating the gains that such coverage can bring, they also identify the limitations and inequities that might still persist or even arise despite expanded coverage, and how these may be related to institutional design and policies. The findings demonstrate the potential for cross-regional learning and comparison at a time when governments across the world, including in USA and other developed and developing countries. are focused on improving health coverage and reducing inequalities in risk protection.