Accessing health services in different countries across the world can lead to individuals having to pay large proportions of the costs--known as catastrophic expenditure--from their available income; such expenditure can push many households into poverty. The potential impact of how health systems are financed on the wellbeing of households, particularly poor households, has affected the design of health systems and insurance mechanisms in countries as diverse as the USA, Australia, India, and Indonesia. The protection of people from catastrophic payments is widely accepted as a desirable objective of health policy. Catastrophic health expenditure is not always a reflection of high health-care costs. A large bill for surgery, for example, might not be catastrophic if a household does not bear the full cost because the service is provided free or at a subsidised price, or is covered by third-party insurance. Conversely, small costs for common treatments can be financially disastrous for poor households with no insurance cover.

Christopher Murray, Ke Xu, and colleagues from WHO, Geneva, Switzerland used data from household surveys in 59 countries to explore variables associated with catastrophic health expenditure. Catastrophic expenditure was defined as a household's financial contributions to the health system in excess of 40% of household income remaining after subsistence needs had been met.

The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries, from less than 0.01% in Czech Republic and Slovakia to 10.5% in Vietnam. Most developed countries have advanced social institutions such as social insurance or tax-fu
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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
10-Jul-2003