title: Impact of the application of the Value Added Tax to imaging tests on out-of-pocket health expenses of households in Chile.
abstract: BACKGROUND
  Out-of-pocket healthcare expense represents a challenge for health systems for it constitutes a barrier to health care, impacting the equality of access to healthcare systems, something particularly important in the Chilean health system. In this context, the Government recently raised the possibility of incorporating a tax on imaging tests, creating debate over its potential consequences.
  
  
  OBJECTIVE
  To explore the impact on household out-of-pocket healthcare expense by the implementation of a value added tax to imaging tests in Chile.
  
  
  METHODS
  Cross-sectional study using data of household expenditures from the VII Household Budget Survey. Out-of-pocket healthcare expense and catastrophic household expenses are calculated comparing two scenarios, with and without the inclusion of the proposed tax. Analyses are presented by income deciles to explore the differential equality impact.
  
  
  RESULTS
  42.8% of diagnostic test expense on household corresponds to imaging studies. Under a scenario of tax implementation, a relative increase of 1.1% of out-of-pocket expenses and 2.2% of catastrophic household expenses is observed. The groups that suffer the greatest impact are those with lower income levels, concentrating in the first fifth deciles.
  
  
  CONCLUSIONS
  We conclude that, although the increase in the average out-of- pocket spending is moderate, this policy may involve a significant increase in the catastrophic expense of the population with the lowest incomes, thereby increasing health inequalities. Considering the challenges of health system financing in Chile, it appears that such fiscal policy would only worsen the possibility of moving towards lower levels of out-of-pocket of household expenses.
authors.affiliation: Programa de Políticas, Sistemas y Gestión en Salud, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile. Address: Avenida Independencia 939, Santiago, Chile. Email: cristobalcuadrado@med.uchile.cl.
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Cuadrado
authors.affiliation: Programa de Políticas, Sistemas y Gestión en Salud, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Silva-Illanes
mesh_terms: D002677:Chile; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000191:economics*; D005382:Financing, Personal / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D007182:Income; D011795:Surveys and Questionnaires; D013660:Taxes / Q000191:economics*
keywords: diagnostic tests; healthcare financing; out of pocket expenditures; taxes