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- 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.