Socioeconomic inequality in catastrophic health expenditure in Brazil.

Alexandra Crispim Boing,Karen Glazer Peres,Aluísio Jardim Dornellas De Barros,Andréa Dâmaso Bertoldi,Leila Garcia Posenato

doi:10.1590/s0034-8910.2014048005111

Abstract

OBJECTIVE To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families.METHODS Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family’s capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index.RESULTS The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated.CONCLUSIONS There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.

Highlights

There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality
In 2002-2003, 78.0% of the researched households were concentrated in urban areas, 26.1% were families led by women, 40.2% had children, 24.0% were senior citizens, and 60.2% of the heads of family were over the age of 40
When Catastrophic health expenditure (CHE) was calculated in relation to total consumption, the increase was of 25.0% at the cutoff point of 10.0%, reaching up to 62.0% when the cutoff point was considered to be 20.0%

Summary

Introduction

Regardless of the method selected for its calculation, CHE has great repercussions on people’s lives, discouraging them at times from using health services and resulting in their non-adherence to medicinal therapies and postponement of physical examinations, consultations, and necessary procedures.a In addition, this may result in a reduction in consumption of the goods and services essential to people’s daily lives, exposing families to social risk and quite often to economic ruin.[18]. Health expenditure in Brazil is especially concerning. Between 1995 and 2010, an increase in public health expenditure was observed; this was accompanied by greater expenditure by families and organizations with health plans and in direct costs.[8,9] the country possesses a public health system boasting universality, integrity and equality, it is one of the few in the world where the private health expenditure surpasses government expenditure.a

Methods

Results

Conclusion