abstract: 'Background Catastrophic health expenditure (CHE) is well established as

  an indicator of financial protection on which there is extensive

  literature. However, most works analyse mainly low to middle income

  countries and do not address the different distributional dimensions of

  CHE. We argue that, besides incidence, the latter are crucial to better

  grasp the scope and nature of financial protection problems. Our

  objectives are therefore to analyse the evolution of CHE in a high

  income country, considering both its incidence and distribution. Methods

  Data are taken from the last three waves of the Portuguese Household

  Budget Survey conducted in 2005/2006, 2010/2011 and 2015/2016. To

  identify CHE, the approach adopted is capacity to pay/normative food

  spending, at the 40\% threshold. To analyse distribution, concentration

  curves and indices (CI) are used and adjusted odds ratios are

  calculated. Results The incidence of CHE was 2.57, 1.79 and 0.46\%, in

  2005, 2010 and 2015, respectively. CHE became highly concentrated among

  the poorest (the respective CI evolved from - 0.390 in 2005 to - 0.758

  in 2015) and among families with elderly people (the absolute CI evolved

  from 0.520 in 2005 to 0.740 in 2015). Absolute CI in geographical

  context also increased over time (0.354 in 2015, 0.019 in 2005).

  Medicines represented by far the largest share of catastrophic payments,

  although, in this case concentration decreased (the median share of

  medicines diminished from 93 to 43\% over the period analysed).

  Contrarily, the weight of expenses incurred with consultation fees has

  been growing (even for General Practitioners, despite the NHS coverage

  of primary care). Conclusions The incidence of CHE and inequality in its

  distribution might progress in the same direction or not, but most

  importantly policy makers should pay attention to the distributional

  dimensions of CHE as these might provide useful insight to target

  households at risk. Greater concentration of CHE can actually be

  regarded as an opportunity for policy making, because interventions to

  tackle CHE become more confined. Monitoring the distribution of payments

  across services can also contribute to early detection of emerging (and

  even, unexpected) drivers of catastrophic payments.'
affiliation: 'Quintal, C (Corresponding Author), Univ Coimbra, Fac Econ, FEUC, CeBER,CEISUC,
  Ave Dias da Silva 165, P-3004512 Coimbra, Portugal.

  Quintal, Carlota, Univ Coimbra, Fac Econ, FEUC, CeBER,CEISUC, Ave Dias da Silva
  165, P-3004512 Coimbra, Portugal.'
article-number: '145'
author: Quintal, Carlota
author-email: qcarlota@fe.uc.pt
author_list:
- family: Quintal
  given: Carlota
da: '2023-09-28'
doi: 10.1186/s12939-019-1044-9
eissn: 1475-9276
files: []
journal: INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH
keywords: 'Catastrophic health expenditure; Financial protection; Inequality;

  Portugal'
keywords-plus: 'OF-POCKET PAYMENTS; FINANCIAL PROTECTION; CONCENTRATION INDEX; CARE

  EXPENDITURE; HOUSEHOLDS; BINARY; EQUITY'
language: English
month: SEP 18
number: '1'
number-of-cited-references: '46'
orcid-numbers: Quintal, Carlota/0000-0002-8306-3431
papis_id: 796da9f461919558f1e622fbd378a865
ref: Quintal2019evolutioncatastrophi
researcherid-numbers: 'Quintal, Carlota/AAE-9866-2020

  '
times-cited: '10'
title: 'Evolution of catastrophic health expenditure in a high income country: incidence
  versus inequalities'
type: article
unique-id: WOS:000486991400001
usage-count-last-180-days: '1'
usage-count-since-2013: '7'
volume: '18'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2019'