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

Samuel López-López, Raúl del Pozo-Rubio, Marta Ortega-Ortega and Francisco Escribano-Sotos
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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
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
Authors registered in the RePEc Author Service: Francisco Escribano Sotos ()

IJERPH, 2021, vol. 18, issue 3, 1-18

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.

Keywords: Spain; out-of-pocket payments; health; catastrophic; health insurance; households; economic crisis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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