title: Out-of-pocket expenditure and financial protection in the Chilean health care system-A systematic review.
abstract: BACKGROUND
  Protection against financial risk due to medical spending is an explicit health guarantee within Chile's AUGE health reform. This paper seeks to analyze the degree to which out-of-pocket expenditure still expose Chilean households to financial catastrophe and impoverishment, and to explore inequalities in financial protection.
  
  
  METHODS
  A systematic literature review was conducted to identify empirical studies analyzing financial protection in Chile. The search included databases as well as grey literature, i.e. governmental and institutional webpages. The indicators are based on the conceptual framework of financial protection, as portrayed in the World Health Report 2013.
  
  
  RESULTS
  We identify n=16 studies that fulfill the inclusion criteria. Empirical studies indicate that 4% of Chilean households faced catastrophic health expenditure defined as out-of-pocket expenditure exceeding 30% of household's capacity to pay, while less than 1% were pushed into poverty in 2012. In contrast to prior studies, recent data report that even publicly insured who should be fully protected from co-payments were affected by catastrophic health expenditure. Also in the private insurance system financial catastrophe is a common risk.
  
  
  CONCLUSIONS
  Despite health reform efforts, financial protection is insufficient and varies to the disadvantage of the poor and vulnerable groups. More research is required to understand why current mechanisms are not as effective as expected and to enable according reforms of the insurance system.
authors.affiliation: Universität Bayreuth, Universitätsstr. 30, Bayreuth, 95447, Germany. Electronic address: kira-johanna.koch@uni-bayreuth.de.
authors.forename: Kira Johanna
authors.initials: KJ
authors.lastname: Koch
authors.affiliation: Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 2nd Floor, 8330077 Santiago de Chile, Chile.
authors.forename: Camilo
authors.initials: C
authors.lastname: Cid Pedraza
authors.affiliation: Universität Bayreuth, Universitätsstr. 30, Bayreuth, 95447, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmid
mesh_terms: D002388:Catastrophic Illness / Q000191:economics*; D002677:Chile; D005382:Financing, Personal / Q000706:statistics & numerical data*; D018166:Health Care Reform; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D011203:Poverty; D012959:Socioeconomic Factors
keywords: AUGE reform; Catastrophic health expenditure; Chile; Financial protection; Impoverishment; Out-of-pocket expenditure