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Abstract(s)
Background/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.
Description
Keywords
Equity in finance Portugal Out-of-pocket payments
Citation
Quintal, Carlota; Lopes, José (2014). Equity in health care financing in Portugal: findings from the Househotd Budget Survey 2010-2011. In 10 th world Congress in health Economics. Dublin, Ireland