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Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain

Author

Listed:
  • Samuel López-López

    (Castilla-La Mancha Health Services, SESCAM, Hospital of Cuenca, C/Hermandad de Donantes de Sangre, 1, 16002 Cuenca, Spain)

  • Raúl del Pozo-Rubio

    (Department of Economic Analysis and Finance, University of Castilla-La Mancha, Avda. Los Alfares, 44, 16071 Cuenca, Spain
    Research Group on Food, Economy and Society, University of Castilla-La Mancha, Avda. Los Alfares, 44, 16071 Cuenca, Spain)

  • Marta Ortega-Ortega

    (Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Campus de Somosaguas s/n, Pozuelo de Alarcón, 28223 Madrid, Spain)

  • Francisco Escribano-Sotos

    (Research Group on Food, Economy and Society, University of Castilla-La Mancha, Avda. Los Alfares, 44, 16071 Cuenca, Spain
    Department of Economic Analysis and Finance, University of Castilla-La Mancha, Plaza de la Universidad s/n, 02001 Albacete, Spain)

Abstract

Background. The financial effect of households’ out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is almost nonexistent after the financial crisis of 2008. The aim of the work is to analyze the incidence and intensity of financial catastrophism derived from Spanish households’ out-of-pocket payments associated with health care during the period 2008–2015. Methods. The Household Budget Survey was used and catastrophic measures were estimated, classifying the households into those above the threshold of catastrophe versus below. Three ordered logistic regression models and margins effects were estimated. Results. The results reveal that, in 2008, 4.42% of Spanish households dedicated more than 40% of their income to financing out-of-pocket payments in health, with an average annual gap of EUR 259.84 (DE: EUR 2431.55), which in overall terms amounts to EUR 3939.44 million (0.36% of GDP). Conclusion. The findings of this study reveal the existence of catastrophic households resulting from OOP payments associated with health care in Spain and the need to design financial protection policies against the financial risk derived from facing these types of costs.

Suggested Citation

  • Samuel López-López & Raúl del Pozo-Rubio & Marta Ortega-Ortega & Francisco Escribano-Sotos, 2021. "Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain," IJERPH, MDPI, vol. 18(3), pages 1-18, January.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:3:p:932-:d:484800
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    References listed on IDEAS

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    1. Marta Ortega-Ortega & Raúl Pozo-Rubio, 2019. "Catastrophic financial effect of replacing informal care with formal care: a study based on haematological neoplasms," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(2), pages 303-316, March.
    2. Yerramilli, Pooja & Fernández, Óscar & Thomson, Sarah, 2018. "Financial protection in Europe: a systematic review of the literature and mapping of data availability," Health Policy, Elsevier, vol. 122(5), pages 493-508.
    3. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    4. Grigorakis, Nikolaos & Floros, Christos & Tsangari, Haritini & Tsoukatos, Evangelos, 2016. "Out of pocket payments and social health insurance for private hospital care: Evidence from Greece," Health Policy, Elsevier, vol. 120(8), pages 948-959.
    5. Francisco Martí & Javier J. Pérez, 2015. "Spanish Public Finances through the Financial Crisis," Fiscal Studies, Institute for Fiscal Studies, vol. 36, pages 527-554, December.
    6. Raúl Del Pozo-Rubio & Isabel Pardo-García & Francisco Escribano-Sotos, 2020. "Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment," IJERPH, MDPI, vol. 17(1), pages 1-19, January.
    7. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    8. Kim, Sujin & Kwon, Soonman, 2015. "Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea," Social Science & Medicine, Elsevier, vol. 138(C), pages 241-247.
    9. Antonello Maruotti, 2009. "Fairness of the national health service in Italy: a bivariate correlated random effects model," Journal of Applied Statistics, Taylor & Francis Journals, vol. 36(7), pages 709-722.
    10. Hacer Özgen Narcı & İsmet Şahin & Hasan Yıldırım, 2015. "Financial catastrophe and poverty impacts of out-of-pocket health payments in Turkey," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 255-270, April.
    11. del Pozo-Rubio, Raúl & Jiménez-Rubio, Dolores, 2019. "Catastrophic risk associated with out-of-pocket payments for long term care in Spain," Health Policy, Elsevier, vol. 123(6), pages 582-589.
    12. Reeves, Aaron & McKee, Martin & Basu, Sanjay & Stuckler, David, 2014. "The political economy of austerity and healthcare: Cross-national analysis of expenditure changes in 27 European nations 1995–2011," Health Policy, Elsevier, vol. 115(1), pages 1-8.
    13. Sofia A. Perez & Manos Matsaganis, 2018. "The Political Economy of Austerity in Southern Europe," New Political Economy, Taylor & Francis Journals, vol. 23(2), pages 192-207, March.
    14. Gallo, Pedro & Gené-Badia, Joan, 2013. "Cuts drive health system reforms in Spain," Health Policy, Elsevier, vol. 113(1), pages 1-7.
    15. Kronenberg, Christoph & Barros, Pedro Pita, 2014. "Catastrophic healthcare expenditure – Drivers and protection: The Portuguese case," Health Policy, Elsevier, vol. 115(1), pages 44-51.
    16. Jelena Arsenijevic & Milena Pavlova & Bernd Rechel & Wim Groot, 2016. "Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-18, July.
    17. Lucia Quaglia & Sebasti�n Royo, 2015. "Banks and the political economy of the sovereign debt crisis in Italy and Spain," Review of International Political Economy, Taylor & Francis Journals, vol. 22(3), pages 485-507, June.
    18. Richard Williams, 2006. "Generalized ordered logit/partial proportional odds models for ordinal dependent variables," Stata Journal, StataCorp LP, vol. 6(1), pages 58-82, March.
    19. Xenia Scheil‐Adlung & Jacopo Bonan, 2013. "Gaps in social protection for health care and long‐term care in Europe: Are the elderly faced with financial ruin?," International Social Security Review, John Wiley & Sons, vol. 66(1), pages 25-48, January.
    20. Łuczak, Julita & García-Gómez, Pilar, 2012. "Financial burden of drug expenditures in Poland," Health Policy, Elsevier, vol. 105(2), pages 256-264.
    21. Panos Kanavos & Olivier Wouters & Anna Zawada & Katarzyna Kolasa & Christian Kronborg & Daniel Rabczenko & Tomasz Rybnik & Jørgen T. Lauridsen & Urszula Ceglowska & Tomasz Hermanowski, 2017. "A Comparison of the Burden of Out-of-Pocket Health Payments in Denmark, Germany and Poland," Global Policy, London School of Economics and Political Science, vol. 8, pages 123-130, March.
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