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What Policy Approaches Were Effective in Reducing Catastrophic Health Expenditure? A Systematic Review of Studies from Multiple Countries

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Abstract

Background

The United Nations set a goal for universal health coverage in all countries by 2030 and selected the catastrophic health expenditure (CHE) indicator as an assessment tool for this goal. Many countries have strived to reduce household CHE. However, no study has compared countries whose policies have had a remarkable effect on decreasing CHE. Therefore, the purpose of this systematic literature review is to find appropriate methods for measuring CHE that can help us to analyze the impact of health policies and identify countries whose health policies are most effective in reducing CHE.

Method

PubMed and Web of Science were searched. Studies that measured the incidence or intensity of CHE in multiple years were included. Two independent reviewers screened the literature, extracted the data, and analyzed the studies selected. Thirty-eight studies met the inclusion criteria for the review. We classified the selected research papers to random sampling and quasi-experimental studies.

Results

We graphically presented the results of CHE incidence and intensity rates reported in the collected papers as a time series data set. Since most studies did not use sample weights, it was not easy to confirm whether the time series changes of CHE are significant. Therefore, we could find only two countries that had policy effects. Both countries established policies that focus on the poor.

Conclusion

There are so many studies that analyze CHE, but policies that are effective in reducing CHE are unknown. This study uses a systematic literature review methodology to determine effective policies by comparing CHE time series trends among countries. As a policy implication, it was found that because CHE is defined as the ratio of the ability to pay to medical expenses, a policy of differential medical expenses that is based on income level is effective.

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Acknowledgements

The authors are grateful to Lee Min for valuable comments on the earlier draft of this paper. We also thank enago (https://www.enago.co.kr/) for English language editing. The authors are also grateful to two anonymous reviewers and editorial boards for the invaluable suggestions.

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  1. Department of Health Administration, Graduate School·BK21 Graduate Program of Developing Glocal Experts in Health Policy and Management, Yonsei University, Changjo Hall, Room Number 419, Yonseidaegil 1, Gangwon-do, Wonju, South Korea

    HyunWoo Jung & Kwang-Soo Lee

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Contributions

HW and KS conceptualized the systematic review and developed the search criteria. Then HW collected research papers, and HW and KS were involved in data extraction. HW prepared the first draft of the manuscript. KS reviewed the drafts of the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Kwang-Soo Lee.

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All data analyzed as part of this research are included in this published article and its supplementary files.

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Jung, H., Lee, KS. What Policy Approaches Were Effective in Reducing Catastrophic Health Expenditure? A Systematic Review of Studies from Multiple Countries. Appl Health Econ Health Policy 20, 525–541 (2022). https://doi.org/10.1007/s40258-022-00727-y

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