title: Household catastrophic health expenditure: a multicountry analysis.
abstract: BACKGROUND
  Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. Yet catastrophic expenditure is not rare. We investigated the extent of catastrophic health expenditure as a first step to developing appropriate policy responses.
  
  
  METHODS
  We used a cross-country analysis design. Data from household surveys in 59 countries were used to explore, by regression analysis, variables associated with catastrophic health expenditure. We defined expenditure as being catastrophic if a household's financial contributions to the health system exceed 40% of income remaining after subsistence needs have been met.
  
  
  RESULTS
  The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries. Catastrophic spending rates were highest in some countries in transition, and in certain Latin American countries. Three key preconditions for catastrophic payments were identified: the availability of health services requiring payment, low capacity to pay, and the lack of prepayment or health insurance.
  
  
  CONCLUSIONS
  People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection. Increase in the availability of health services is critical to improving health in poor countries, but this approach could raise the proportion of households facing catastrophic expenditure; risk protection policies would be especially important in this situation.
authors.affiliation: Evidence and Information for Policy, World Health Organization, 20 Avenue Appia, CH-1211 27, Geneva, Switzerland.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: David B
authors.initials: DB
authors.lastname: Evans
authors.forename: Kei
authors.initials: K
authors.lastname: Kawabata
authors.forename: Riadh
authors.initials: R
authors.lastname: Zeramdini
authors.forename: Jan
authors.initials: J
authors.lastname: Klavus
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
mesh_terms: D002388:Catastrophic Illness / Q000191:economics*; D003906:Developing Countries / Q000191:economics; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics; D006306:Health Surveys; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000191:economics; D011203:Poverty; D012044:Regression Analysis