Loading...
4 results
Search Results
Now showing 1 - 4 of 4
- Equity in health care financing in Portugal: findings from the Househotd Budget Survey 2010-2011Publication . Quintal, Carlota; Lopes, JoséBackground/objectives: Equity in health care financing is recognized as a main-goal of health policy. There is broad consensus on the normative assumption that healthcare payments should be linked to ability to pay with use related to need, and that ali households should be protected against catastrophic financiai losses related to ill health. The link between payment and capacity to pay hás been evaluated through progressivity índices and protection against financial losses has been assessed through the analysis of catastrophic health payments (CHE), expenditure so high that it might mean that people have to cut down on necessities such as food, clothing or education. CHE is more likely in countries that lack prepayment mechanisms for risk pooling. Empirical data show that CHE remains low in countries where out-of-pocket payments (OOP) represent less than 15-20% of total national health expenditure and where the general government health expenditure is above 5-6% of GDP. In Portugal, in 2010, OOP represented 26% of total health expenditure and government health expenditure was 7% of GDP. This study aims to identify the proportion of households with CHE in Portugal and household factors predicting this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Methods: Data carne from the Portuguese Household Budget Survey 2010/201 1 (9489 observations). CHE was calculated using WHO methodology (Xu, 2005); multiple logistic regression analysis was used to identify determinants of CHE; and the convenient regression method was used to calculate the Kakwani index. Results: The global prevalence of CHE is 2.11%, occurring in all expenditure quintiles (4.1% in the 1 stand 1.1% in the 5th). Analyzing the various components of expenditure, the most striking differences across expenditure quintiles refer to medicines (account for 78% of total health expenditure in the 1st expenditure quintile while they weigh 42% in the 5th) and dentist services (weigh 2.48% in the 1st quintile and 18% in the 5th). In the logistic model, households with at least one old person (65 years or more) face 5.3 times more catastrophe than households without elderly members (OR=5. 27; IC= 3.324-8.358); head of household with basic education (compared to secondary/superior) increases risk of CHE (OR= 2.39; IC= 1.342-4.257). Other covariates were not statistically significant. Regarding the Kakwani index, for total OOP it is -0.074 (p-value=0. 000) and for medicines it is -0.225 (p-value=0.000); in terms of regions, Kakwani index is larger for the Centre (-0.132; p-value=0. 000) and lower, not significant, for Azores (0.016; p-value=0.656); for health insurance it is 0.098 (p-value=0. 000). Conclusions: Portugal has a NHS, accessible to all citizens; still, households face a considerable risk of CHE and OOP are particularly regressive in the case of medicines. Although comparisons are not straightforward, the prevalence of CHE in Portugal is at the same level as in many low, and low-middle, income countries. This is a worrying result in a context of high unemployment and wage cuts. Authorities should pay attention to the most vulnerable, especially households with elderly members, and think carefully on policy measures regarding medicine co-payments.
- Equity in health care financing in Portugal: findings from the Household Budget Survey 2010-2011Publication . Quintal, Carlota; Lopes, JoséEquity in health care financing is recognised as a main goal of health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related with the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, in 2010, OOP represented 26 per cent of total health expenditure (one of the highest among OECD countries). This study aims to identify the proportion of households with CHE in Portugal and household factors predicting this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data came from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.11 per cent which is too high for a developed country with a universal National Health Service. Households with at least one old person face 5.3 times more catastrophe and head of household with basic education (compared to secondary/superior) doubles the risk of CHE. Payments are particularly regressive for the case of medicines. The Kakwani index is larger (negative) for the Centre and lower, not significant, for Azores; payments for voluntary health insurance are progressive.
- Equity in health care financing in Portugal: findings from the Household Budget Survey 2010/2011Publication . Quintal, Carlota; Lopes, JoséEquity in health care financing is recognised as a main goal in health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related to the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, OOP represented 26% of total health expenditure in 2010 [one of the highest among Organisation for Economic Co-operation and Development (OECD) countries]. This study aims to identify the proportion of households with CHE in Portugal and the household factors associated with this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data were taken from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.1%, which is high for a developed country with a universal National Health Service. The main factor associated with CHE is the presence of at least one elderly person in households (when the risk quadruples). Payments are particularly regressive for medicines. Regarding the results by regions, the Kakwani index for total OOP is larger (negative) for the Centre and lower, not significant, for the Azores. Payments for voluntary health insurance are progressive.
- Catastrophic expenditure on medicines: an analysis based on the portuguese household budget survey 2015/2016Publication . Quintal, Carlota; Lopes, JoséFinancial protection is a core dimension of health system evaluation and several works on catastrophic health expenditure (CHE) have been developed. There are however some gaps in the literature, hence, this work aims to look at CHE from a different angle, following the money spent by households. The objectives are to identify how many and which health services are driving CHE and analyse the profile of households with CHE. Data come from the Portuguese Household Budget Survey 2015/2016 and the study includes 11,398 observations. WHO methodology for CHE identification was adopted. Over a fifth of households incurring CHE spent only on medicines and this item presented by far the highest expenditures. All families with CHE spent on medicines and about two thirds spent on up to three items. Expenditures on medical devices and hospital services were low. Dental care expenditures tended to assume extreme values. Although primary care services are spread across the country, expenditures on GP services were not at all negligible. The typical household with CHE consists of an old poor person living alone. Exempting these people from medicine co-payments is crucial to prevent catastrophic expenditure.