PNS31 OUT-OF-POCKET HEALTH EXPENDITURES IN COLOMBIA: A SYSTEMATIC REVIEW

Abstract

To review the evidence of out-of-pocket (OOPE) and catastrophic expenditures (CHE) in health in Colombia. Systematic review of the literature (SLR). Searches were performed in PubMed, Scopus, Scielo and Google Scholar. We used the MESH terms: out-of-pocket, catastrophic health expenditure, health and Colombia. We included cost description or cost analysis studies. Cost-effectiveness analysis of health technologies and qualitative studies were excluded. Data about period of analysis, type of study, costing perspective, OOPE, and CHE were extracted. Studies were classified as macroeconomic, microeconomic, and diseases analysis. All costs were indexed to 2018 and reported in Colombian pesos (COP). We found 44 studies, 15 were duplicated. Twenty full-text papers were revised and 17 were finally included. Six studies were prospective, seven from patient perspective and four from societal perspective. Only five studies estimated CHE. Macroeconomic analysis: between 1993-2011, the average OOPE was 18% of total health expenditure and 1.1% of Colombian GDP. Microeconomic analysis: Amaya (2016) identified Pacific region as the most vulnerable, with a CHE of 16,9%, ten percentage points higher than Bogotá (lowest CHE). If a woman was head of household, their OOPE increased by 14%. Members of the households at extreme ages augmented the OOPE; if they were children under-5, health expenses increased by 15%, and if they were elderly, by 21%. Disease analysis: OOPE of Chikungunya (3.3% out of the total costs of the disease), HIV (monthly OOPE in antiretroviral therapy: COP$237.153), dengue (OOPE of COP$54.672 per hospitalization), and arterial hypertension (COP$44.548 per cardiac rehabilitation session). OOPE and CHE are not frequently estimated in Colombian health economic studies. Documents reviewed reflect the heterogeneity of the studies. Data sources do not offer availability of data over the time and non-standardized methodologies were frequent.