Catastrophic health expenditure and entitlement to health services in the occupied Palestinian territory: a retrospective analysis

Abstract

BackgroundThe proportion of households that have catastrophic health expenditure in the occupied Palestinian territory increased from 1·16% in 1998, to 2·15% in 2007; however, knowledge about the degree to which different groups of the population are exposed to catastrophic health expenditure is scarce. We assessed possible factors that affect the occurrence of catastrophic health expenditure in the occupied Palestinian territory. MethodsWe analysed data from the Palestinian Consumption and Expenditure Survey, which was collected by the Palestinian Central Bureau of Statistics, mainly during 2010. According to the WHO methods, we classed household health payments as catastrophic if they constituted 40% or more of non-food expenditure. Socioeconomic and demographic categories of households, enrolment in health insurance schemes, and individual characteristics of the family head were grouped and compared with χ2 tests. FindingsOf 3754 households, 1609 (42·9%) were headed by a refugee and 2109 (56·2%) were insured. Catastrophic health expenditure occurred in 90 (2·4%) households. It was more common in uninsured versus insured households (52 of 1645 [3·2%] vs 38 of 2109 [1·8%]; p=0·007). Catastrophic health expenditure was less common for insured refugees (15 of 1024 [1·5%]) than for insured non-refugees (23 of 1085 [2·1%]), uninsured refugees (15 of 585 [2·6%]), and uninsured non-refugees (37 of 1060 [3·5%]; p=0·022). Catastrophic health expenditure differed significantly according to place of residence (Gaza Strip and West Bank) and other household characteristics (household income, proportion of expenditure spent on food, and sex, education, and employment status of the household head). InterpretationCatastrophic health expenditure in the occupied Palestinian territory has steadily increased. The protective effect of entitlement to health services offered to refugees through the United Nations Relief and Work Agency and to insured people, mainly through the Ministry of Health, suggests that any effort to decrease catastrophic health expenditure in the occupied Palestinian territory requires universal health coverage. FundingNone.