Determining factors of catastrophic health spending in Bogota, Colombia

  • Jeannette Liliana Amaya Lara
  • Fernando Ruiz Gómez
Article

Abstract

This study tests whether the low-income population in Bogota not insured under the General Social Security Health System is able to economically handle unexpected health problems or not. It used data from the Health Services Use and Expenditure Study conducted in Colombia in 2001, for which each household recorded its monthly out-of-pocket health expenditure during the year and the household income was measured as the sum of each member’s contribution to the household. Payment capacity or available income and catastrophic health spending were based on the latest methodology proposed by the World Health Organization (WHO) in 2005. A probit model was adjusted to determine the factors that significantly influence the likelihood of a household having catastrophic health spending. The percentage of households with catastrophic health spending in Bogota was 4.9%; incidence was higher in low-income households where none of the members were affiliated to social security, where there had been an in-patient event, and where the heads of household were over 60 years of age. There is no statistical evidence for rejecting the hypothesis under study, which states that low-income households that have no health insurance are more likely to have catastrophic health spending than higher-income households with health insurance.

Keywords

Catastrophic spending Out-of-pocket expenditure Health service inequity Health insurance Health economy 

JEL Classification

I10 I30 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alvis L., Alvis N., de la Hoz F. (2004) Gasto privado en salud de los hogares de Cartagena de Indias. Revista de Salud Pública 9(1): 11–15Google Scholar
  2. Arrow K. J. (1963) Uncertainty and the welfare economics of medical care. The American Economic Review 53(5): 941–973Google Scholar
  3. Berki S. (1963) A look at catastrophic medical expenses and the poor. Health affairs 5(4): 138–145CrossRefGoogle Scholar
  4. Cendex—Centro de Proyectos para el Desarrollo: (2001) Encuesta de Usos y Gastos en Salud. BID—Banco Interamericano de Desarrollo, Colombia. FinanciaciónGoogle Scholar
  5. Corcho, A.E., Castilla, M., & Acosta, N. (2000). Narrativa sobre la Reforma del Sistema de Salud en Colombia. Núcleo de Acopio, Apoyo y Difusión de las Iniciativas de Reforma, Instituto de Salud Pública.Google Scholar
  6. Cruz C., Luna G. A., Morales R., Coello C. G. (2006) Gasto catastrófico en salud y elasticidades ingreso por tipo de gasto en servicios de salud en México. Bienestar y Política Social 2(1): 51–73Google Scholar
  7. Friedman B. (1974) Risk aversion and the consumer choice of health insurance options. The Review of Economics and Statistics 56: 209–214CrossRefGoogle Scholar
  8. Hernández J., Avila L., Valencia A., Poblano O. (2008) Evaluación Inicial del Seguro Popular sobre el Gasto Catastrófico en Salud en México. Revista de Salud Pública de México 10(1): 18–32CrossRefGoogle Scholar
  9. Inter-American Development Bank: (2006) Colombia, Expansion of the program for the reorganization, redesign and modernization of health service networks. Loan Proposal, PIC, CO-L1017Google Scholar
  10. Knaul F., Arreola H., Méndez O. (2005) Protección financiera en salud: México, 1992 a 2004. Revista de Salud Pública de México 47(6): 430–439Google Scholar
  11. Knaul, F., Arreola, H., Méndez, O., & Miranda, M. (2006). Preventing impoverishment promoting equity and protecting households from financial crisis: Universal Health Insurance through Institutional Reform in Mexico. Working Paper Series, Innovations in Health Financing.Google Scholar
  12. Knaul F., Arreola H., Méndez O., Bryson C., Barofsky J., Maguire R., Miranda M., Sesma S. (2007) Las evidencias benefician al sistema de salud: reforma para remediar el gasto catastrófico y empobrecedor en salud en México. Salud Pública de México 49: S70–S87PubMedGoogle Scholar
  13. Limwattananon S., Tangcharoensathien V., Prakongsai P. (2007) Catastrophic and poverty impacts of health payments: results from national household survey in Thailand. Bulletin of the World Health Organization 85: 600–606PubMedCrossRefGoogle Scholar
  14. Manning W. G., Newhouse J. P., Duan N. et al (1987) Health insurance and the demand for medical care: evidence from the randomized experiment. American Economic Review 77(3): 251–277PubMedGoogle Scholar
  15. Merlis, M. (2002). Family out-of-pocket spending for health services: A continuing source of financial insecurity. The Commonwealth Fund.Google Scholar
  16. Mora H. (2000) Riesgo del aseguramiento en el sistema de salud en Colombia en 1997. Serie Financiamiento del desarrollo, N o 95. CEPAL, Mayo, SantiagoGoogle Scholar
  17. O’Donnell, O., van Doorslaer, E., & RananEliya, R., et al. (2005). Explaining the incidence of catastrophic expenditures on health care: Comparative evidence from Asia. EQUITAP Project, working paper #5. Colombo: Erasmus University, Rotterdam and IPS.Google Scholar
  18. O’Donnell, O., van Doorslaer, E., Wagstaff, A., & Lindelow, M. (2008). Catastrophic payments for health care. Chap. 18 in: Analyzing health equity using household survey data: A guide to techniques and their implementation. Washington, DC: The World Bank, WBI Learning Resources SeriesGoogle Scholar
  19. O’Meara G., Ruiz F., Amaya J. L. (2003) Impacto del aseguramiento sobre uso y gasto en salud en Colombia. CEJA, BogotáGoogle Scholar
  20. Pérez R., Sesma S., Puentes E. (2005) Gastos catastróficos por motivos de salud en México: estudio comparativo por grado de marginación. Revista de Salud Pública de México (suplemento) 47(1): S47–S53Google Scholar
  21. Perticara, M. (2008). Incidencia de los gastos de bolsillo en salud en siete países latinoamericanos. CEPAL, Serie Políticas Sociales, No.141, Santiago de Chile.Google Scholar
  22. Ruiz, F., Amaya, J. L., & Venegas, S. (2006). Impacto del aseguramiento sobre uso y gasto en salud en Colombia (pp. 3–18).Google Scholar
  23. Sesma S., Pérez R., Gómez O. (2004) Síntesis Ejecutiva: Magnitud y origen de los gastos catastróficos por motivos de salud por entidad federativa: México 2002-2003. Secretaría de Salud de México, México, DFGoogle Scholar
  24. Sesma S., Pérez R., Sosa C., Gómez O. (2005) Gastos catastróficos por motivos de salud en México: magnitud, distribución y determinantes. Revista de Salud Pública de México 47(1): S37–S46Google Scholar
  25. Torres A. C., Knaul F. (2003) Determinantes del gasto de bolsillo en salud e implicaciones para el aseguramiento universal en México: 1992-2000. Caleidoscopio de la Salud, México, pp 209–225Google Scholar
  26. Universidad Externado de Colombia. (2001). Búsqueda de menores costos, calidad del empleo e informalidad.Boletín del Observatorio del Mercado de Trabajo No. 3.Google Scholar
  27. van de Ven W. P. M., van Praag B. M. S. (1981) Risk aversion and deductibles in private health insurance: application of an adjusted Tobit model to family health care expenditures. Health, Economics and Health Economics. North-Holland, AmsterdamGoogle Scholar
  28. van Doorslaer, E., O’Donnell, O., & Rannan, R.P., et al. (2005). Paying out-of-pocket for health care in Asia: Catastrophic and poverty impact. EQUITAP Project: Working Paper #2.Google Scholar
  29. Wagstaff A., van Doorslaer E. (2003) Catastrophe and impoverishment in paying for health care: With applications to Vietnam 1993–1998. Health Economics 12(11): 921–934PubMedCrossRefGoogle Scholar
  30. Wagstaff, A. (2005). The economic consequences of health shocks. World bank development research group, Policy Research Working Paper 3644, Washington, DC, USA.Google Scholar
  31. Wagstaff A. (2008). Measuring financial protection in health. World bank development research group, Policy Research Working Paper 4554, Washington, DC, USA.Google Scholar
  32. Wooldridge, J. (2002). Econometric analysis of cross section and panel data, MIT Press.Google Scholar
  33. World Health Organization. (2000). Health systems: Improving performance. The World Health Report 2000, Geneva.Google Scholar
  34. Wyszewianski L. (1986a) Financially catastrophic and high cost cases: Definitions, distinctions and their implications for policy formulation. Inquiry 23(4): 382–394PubMedGoogle Scholar
  35. Wyszewianski L. (1986b) Families with catastrophic health care expenditures. Health Services Research 21(5): 617–634PubMedGoogle Scholar
  36. Xu K. (2000) World Health Report 2000. World Health Organization, Geneva, SwitzerlandGoogle Scholar
  37. Xu K., Evans D. B., Kawabata K., Zeramdini R., Klavus J., Murray J. L. C. (2003a) Household catastrophic health expenditure: A multicountry analysis. Lancet 362: 111–117PubMedCrossRefGoogle Scholar
  38. Xu, K., Klavus, J., & Kawabata, K., et al. (2003b). Household health system contributions and capacity to pay: Definitional, empirical, and technical challenges. Chap. 39. In C. J. L. Murray & D. B. Evans, Health systems performance assessment: Debates, methods and empiricism. Geneva:World Health Organization.Google Scholar
  39. Xu, K. (2005). Distribution of health payments and catastrophic expenditures. Methodology. Geneva: WHO–Discussion paper No. 2.Google Scholar
  40. Xu, K., Evans, & D., Aguilar, A.M. (2005). Designing health financing systems to reduce catastrophic health expenditure. Geneva: WHO, Technical Briefs for Policy, Makers No. 2.Google Scholar
  41. Xu K., Evans D. B., Carrin G., Aguilar-Rivera A. M., Musgrove P. et al (2007) Protecting households from catastrophic health spending. Health Aff (Millwood) 26(4): 972–983CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jeannette Liliana Amaya Lara
    • 1
  • Fernando Ruiz Gómez
    • 1
  1. 1.Center for Development Projects–CendexPontificia Universidad JaverianaBogotaColombia

Personalised recommendations