Abstract
BackgroundOut-of-pocket expenditure to pay for health services could result in financial catastrophe. The purpose of this study was to identify the incidence and determinants of catastrophic out-of-pocket payments for healthcare in Colombia. The underlying hypotheses are that low-income and non-insured population in Colombia, and households living in isolated and high level of rurality regions, are more likely to incur catastrophic healthcare expenses.MethodsThis study used data from the Quality of Life National Survey conducted in Colombia in 2011. The presence of catastrophic healthcare spending was calculated using the methodology proposed by the World Health Organization in 2005. Households were classified as having catastrophic health spending when their out-of-pocket health payments were over 20 % of their payment capacity. All other households were classified as not having catastrophic health spending. A probit model was estimated aimed at determining what factors influence the probability of catastrophic healthcare spending.ResultsStudy findings show that 9.6 % of Colombian households had catastrophic expenditure. The incidence was higher in households in the Pacífica and Atlántica regions, extended and nuclear families, households with children or elderly adults, located in rural areas, and not insured under the healthcare system. The ratio of household members who work seems to reduce the risk of catastrophic healthcare spending, but the occurrence of any in-patient event increases it. So, there is no statistical evidence for rejecting the hypotheses under study.ConclusionsResults indicate the importance of establishing intervention mechanisms in order to improve equity in access and payment for health care, protect vulnerable groups against financial risk, and, consequently, reduce the incidence of catastrophic healthcare spending. For this, it is essential to achieve universal health coverage through standardized and improved health services packages for vulnerable age groups and implement healthcare campaigns for households in rural areas where the incidence of out-of-pocket payments is higher.
Highlights
The Colombian health system has improved the access to healthcare services since the 1993 reform, thanks to the creation of subsidized and contributive healthcare policies
Since the enactment of this Law, all Colombians will participate in the essential health service that allows the General Social Security Health System (SGSSS in the Colombian acronym), some of them will do as members of the subsidized or contributive scheme and others will do as so-called non-insured who are not affiliated to any health insurance
The results shows that 9.6 % of Colombian households incurred in catastrophic healthcare spending, with differences according to the region: households in the Pacífica region were the most vulnerable to incurring in catastrophic healthcare spending (16.9 %; 95 % CI = 15.9 %-18.1 %), followed by Atlántica (11.3 %; 95 % CI = 10.2 %-12.5 %), Oriental (9.9 %; 95 % CI = 8.7 %-11.3 %) and Central (9.8 %; 95 % CI = 8.4 %-11.4 %) regions, whereas only 6.1 % of households in the Bogotá and 5.7 % of households in San Andrés had catastrophic healthcare spending
Summary
The Colombian health system has improved the access to healthcare services since the 1993 reform, thanks to the creation of subsidized and contributive healthcare policies. The underlying hypotheses are that low-income and non-insured population in Colombia, and households living in isolated and high level of rurality regions, are more likely to incur catastrophic healthcare expenses. Members of the system by the subsidized regime are people the poorest and most vulnerable population unable to pay to cover the total amount of the contribution and require total or partial subsidy to be able to receive healthcare services. This population is targeted by the Identification System for Potential Program Beneficiaries (SISBEN is the Colombian acronym) created in 1993. Persons placed in levels 1 and 2 in the SISBEN benefit from total or full subsidy under the subsidized social security health policy, provided that such persons are not and should not be insured under the contributive healthcare policy
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