IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v18y2021i3p932-d484800.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/18/3/932/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/1660-4601/18/3/932/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    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. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    11. Łuczak, Julita & García-Gómez, Pilar, 2012. "Financial burden of drug expenditures in Poland," Health Policy, Elsevier, vol. 105(2), pages 256-264.
    12. 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.
    13. 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.
    14. 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.
    15. 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.
    16. 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.
    17. 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.
    18. Gallo, Pedro & Gené-Badia, Joan, 2013. "Cuts drive health system reforms in Spain," Health Policy, Elsevier, vol. 113(1), pages 1-7.
    19. Kronenberg, Christoph & Barros, Pedro Pita, 2014. "Catastrophic healthcare expenditure – Drivers and protection: The Portuguese case," Health Policy, Elsevier, vol. 115(1), pages 44-51.
    20. 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.
    21. repec:bla:glopol:v:8:y:2017:i::p:123-130 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Maria-Carmen García-Centeno & Román Mínguez-Salido & Raúl del Pozo-Rubio, 2021. "The Classification of Profiles of Financial Catastrophe Caused by Out-of-Pocket Payments: A Methodological Approach," Mathematics, MDPI, vol. 9(11), pages 1-20, May.
    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. Samuel López-López & Raúl Pozo-Rubio & Marta Ortega-Ortega & Francisco Escribano-Sotos, 2022. "Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(7), pages 1187-1201, September.
    4. Nikolaos Grigorakis & Christos Floros & Haritini Tsangari & Evangelos Tsoukatos, 2017. "Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 261-287, September.
    5. Aleksandra Kolasa & Ewa Weychert, 2022. "The causal effect of catastrophic health expenditure on poverty in Poland," Working Papers 2022-23, Faculty of Economic Sciences, University of Warsaw.
    6. Chantzaras, Athanasios E. & Yfantopoulos, John N., 2018. "Financial protection of households against health shocks in Greece during the economic crisis," Social Science & Medicine, Elsevier, vol. 211(C), pages 338-351.
    7. Raúl Pozo-Rubio & Román Mínguez-Salido & Isabel Pardo-García & Francisco Escribano-Sotos, 2019. "Catastrophic long-term care expenditure: associated socio-demographic and economic factors," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 691-701, July.
    8. Raúl Del Pozo-Rubio & Fernando Bermejo-Patón & Pablo Moya-Martínez, 2022. "Impact of implementation of the Dependency Act on the Spanish economy: an analysis after the 2008 financial crisis," International Journal of Health Economics and Management, Springer, vol. 22(1), pages 111-128, March.
    9. Kyriopoulos, Ilias & Nikoloski, Zlatko & Mossialos, Elias, 2021. "Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession," Health Policy, Elsevier, vol. 125(9), pages 1256-1266.
    10. 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.
    11. Sarah Ssewanyana & Ibrahim Kasirye, 2020. "Estimating Catastrophic Health Expenditures from Household Surveys: Evidence from Living Standard Measurement Surveys (LSMS)-Integrated Surveys on Agriculture (ISA) from Sub-Saharan Africa," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 781-788, December.
    12. Raúl Del Pozo-Rubio & Pablo Moya-Martínez & Marta Ortega-Ortega & Juan Oliva-Moreno, 2020. "Shadow and extended shadow cost sharing associated to informal long-term care: the case of Spain," Health Economics Review, Springer, vol. 10(1), pages 1-12, December.
    13. Fernando Bermejo & Raúl del Pozo & Pablo Moya, 2021. "Main Factors Determining the Economic Production Sustained by Public Long-Term Care Spending in Spain," IJERPH, MDPI, vol. 18(17), pages 1-18, August.
    14. Sabine Vogler & Guillaume Dedet & Hanne Bak Pedersen, 2019. "Financial Burden of Prescribed Medicines Included in Outpatient Benefits Package Schemes: Comparative Analysis of Co-Payments for Reimbursable Medicines in European Countries," Applied Health Economics and Health Policy, Springer, vol. 17(6), pages 803-816, December.
    15. Baird, Katherine Elizabeth, 2016. "The incidence of high medical expenses by health status in seven developed countries," Health Policy, Elsevier, vol. 120(1), pages 26-34.
    16. Johnston, Bridget M. & Burke, Sara & Barry, Sarah & Normand, Charles & Ní Fhallúin, Maebh & Thomas, Steve, 2019. "Private health expenditure in Ireland: Assessing the affordability of private financing of health care," Health Policy, Elsevier, vol. 123(10), pages 963-969.
    17. Sha Chen & Zhiye Lin & Xiaoru Fan & Jushuang Li & Yao-Jie Xie & Chun Hao, 2022. "The Comparison of Various Types of Health Insurance in the Healthcare Utilization, Costs and Catastrophic Health Expenditures among Middle-Aged and Older Chinese Adults," IJERPH, MDPI, vol. 19(10), pages 1-14, May.
    18. Ahmed Shoukry Rashad & Mesbah Fathy Sharaf, 2015. "Catastrophic Economic Consequences of Healthcare Payments: Effects on Poverty Estimates in Egypt, Jordan, and Palestine," Economies, MDPI, vol. 3(4), pages 1-19, November.
    19. Raúl Pozo-Rubio & Marta Ortega-Ortega, 2022. "Sociodemographic and health factors associated with the risk of financial catastrophe when informal care for patients with haematological neoplasms is replaced by formal care," Health Economics Review, Springer, vol. 12(1), pages 1-12, December.
    20. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:18:y:2021:i:3:p:932-:d:484800. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.