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Equity in health care financing in Portugal: findings from the Household Budget Survey 2010/2011

Published online by Cambridge University Press:  17 November 2015

Carlota Quintal  and
José Lopes
Carlota Quintal*
Affiliation:
Faculty of Economics & CEISUC, University of Coimbra, Coimbra, Portugal
José Lopes
Affiliation:
Polytechnic Institute of Bragança, Department of Economics and Management, Bragança, Portugal
*
*Correspondence to: Carlota Quintal, Faculty of Economics, University of Coimbra, Avenida Dias da Silva 165, 3004–512 Coimbra, Portugal. Email: qcarlota@fe.uc.pt
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Abstract

Equity in health care financing is recognised as a main goal in health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related to the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, OOP represented 26% of total health expenditure in 2010 [one of the highest among Organisation for Economic Co-operation and Development (OECD) countries]. This study aims to identify the proportion of households with CHE in Portugal and the household factors associated with this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data were taken from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.1%, which is high for a developed country with a universal National Health Service. The main factor associated with CHE is the presence of at least one elderly person in households (when the risk quadruples). Payments are particularly regressive for medicines. Regarding the results by regions, the Kakwani index for total OOP is larger (negative) for the Centre and lower, not significant, for the Azores. Payments for voluntary health insurance are progressive.

Type
Articles
Information
Health Economics, Policy and Law , Volume 11 , Issue 3 , July 2016 , pp. 233 - 252
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Copyright
© Cambridge University Press 2015 

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References

Adda, J. and Lechene, V. (2013), ‘Health selection and the effect of smoking on mortality’, The Scandinavian Journal of Economics, 115: 902–931.CrossRefGoogle Scholar
Aristei, D. and Pieroni, L. (2009), ‘Addiction, social interactions and gender differences in cigarette consumption’, Empirica, 36: 245–272.CrossRefGoogle Scholar
Arsenijevic, J., Pavlova, M. and Groot, W. (2013), ‘Measuring the catastrophic and impoverishing effect of household health care spending in Serbia’, Social Science & Medicine, 78: 17–25.CrossRefGoogle ScholarPubMed
Baji, P., Pavlova, M., Gulácsi, L. and Groot, W. (2012), ‘Changes in equity in out-of-pocket payments during the period of health care reforms: evidence from Hungary’, International Journal for Equity in Health, 11: 36.CrossRefGoogle ScholarPubMed
Barros, P. (2012), ‘Health policy reform in tough times: the case of Portugal’, Health Policy, 106: 17–22.CrossRefGoogle ScholarPubMed
Barros, P., Machado, S. and Simões, J. (2011), ‘Portugal: health system review’, Health Systems in Transition, 13: 1–156.Google ScholarPubMed
Barros, P., Cristóvão, R. and Gomes, P. (2013), ‘Chapter 13: Portugal’, in L. Siciliani, M. Borowitz and V. Moran (eds), Waiting Time Policies in the Health Sector: What Works?, OECD Health Policy Studies, Paris: OECD Publishing.Google Scholar
Caritas Europa (2015), Poverty and Inequalities on the Rise, Brussels: Caritas Europa.Google Scholar
Carone, G., Schwierz, C. and Xavier, A. (2012), Cost Containment Policies in Public Pharmaceutical Spending in the EU, Brussels: European Commission.CrossRefGoogle Scholar
Devaux, M. and Looper, M. (2012), Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008–2009, OECD Health Working Papers No. 58, OECD Publishing.Google Scholar
European Central Bank, European Commission and International Monetary Fund (2011), Portugal: Memorandum of Understanding on Specific Economic Policy Conditionality, http://www.bportugal.pt/pt-PT/OBancoeoEurosistema/ProgramaApoioEconomicoFinanceiro/Documents/IMF_country-report_11-127_June2011.pdf [24 February 2014].CrossRefGoogle Scholar
Gupta, I. and William, J. (2013), ‘Refining estimates of catastrophic healthcare expenditure: an application in the Indian context’, International Journal of Health Care Finance and Economics, 13: 157–172.CrossRefGoogle ScholarPubMed
INE (2012), ‘Household Budget Survey 2010/2011 – Methodological Document’, Lisbon, Statistics Portugal, http://www.ine.pt/investigadores/IDEF2010_DM_v2.0%28vp%29.pdf [21 April 2015] (in Portuguese).Google Scholar
Kakwani, N., Wagstaff, A. and van Doorslaer, E. (1997), ‘Socioeconomics inequalities in health: measurement, computation and statistical inference’, Journal of Econometrics, 77: 87–103.CrossRefGoogle Scholar
Kenkel, D. (2015), ‘The Effect of Income on Adult Cigarette Consumption and Smoking Cessation’, http://www.researchgate.net/publication/254069211_The_Effect_of_Income_on_Adult_Cigarette_Consumption_and_Smoking_Cessation [28 April 2015].Google Scholar
Kravitz, A. S., Bullock, A., Cowpe, J. and Barnes, E. (2014), Manual of Dental Practice – Portugal, Brussels: The Council of European Dentists.Google Scholar
Kronenberg, C. and Barros, P. P. (2014), ‘Catastrophic healthcare expenditure – drivers and protection: the Portuguese case’, Health Policy, 115(1): 44–51.CrossRefGoogle ScholarPubMed
Lakhdar, C. B., Cauchie, G., Vaillant, N. J. and Wolff, F.-C. (2012), ‘The role of family incomes in cigarette smoking: evidence from French students’, Social Science & Medicine, 74: 1864–1873.CrossRefGoogle ScholarPubMed
Lara, J. L. and Gómez, F. R. (2011), ‘Determining factors of catastrophic health spending in Bogota, Colombia’, International Journal of Health Care Finance and Economics, 11: 83–100.CrossRefGoogle Scholar
Morgan, D. and Astolfi, R. (2015), ‘Financial impact of the GFC: health care spending across the OECD’, Health Economics, Policy and Law, 10: 7–19.CrossRefGoogle ScholarPubMed
Narci, H. O., Sahin, I. and Yildirim, H. H. (2015), ‘Financial catastrophe and poverty impacts of out-of-pocket health payments in Turkey’, The European Journal of Health Economics, 16: 255–270.CrossRefGoogle Scholar
Nguyen, L., Rosenqvist, G. and Pekurinen, M. (2012), Demand for Tobacco in Europe: An Econometric Analysis of 11 Countries for the PPACTE Project, Tampere: National Institute for Health and Welfare.Google Scholar
O’Donnell, O., van Doorslaer, E., Wagstaff, A. and Lindelow, M. (2008), Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation, Washington, DC: The World Bank.Google Scholar
Organisation for Economic Co-operation and Development (OECD) (2014a), Health at a Glance 2014: OECD Indicators, Paris: OECD Publishing.Google Scholar
Organisation for Economic Co-operation and Development (OECD) (2014b), Society at a Glance 2014: OECD Social Indicators, Paris: OECD Publishing.Google Scholar
OPSS (2014), Health – Syndrome of Denial, The Spring Report of the Portuguese Observatory on Health Systems, http://www.observaport.org/sites/observaport.org/files/RelatorioPrimavera2014.pdf [26 July 2014] (in Portuguese).Google Scholar
Pordata (2015), Gini Index in Portugal, http://www.pordata.pt/en/Portugal/Gini+index-2166 [28 April 2015].Google Scholar
Quintal, C. and Venceslau, S. (2011), ‘“Equity in out-of-pocket health care payments in Portugal: a global analysis and by NUTS II”’, Revista Portuguesa de Estudos Regionais, 25–26: 55–66 (in Portuguese).Google Scholar
Simões, J., Barros, P. and Pereira, J. (coordinators) (2007), Final Report of the Commission for the Financing Sustainability of the National Health Service, Lisbon: Ministry of Health. (in Portuguese).Google Scholar
Smith, P. C. (2013), ‘Universal health coverage and user charges’, Health Economics, Policy and Law, 8(4): 529–535.CrossRefGoogle ScholarPubMed
Thomson, S., Foubister, T. and Mossialos, E. (2009), Financing Health Care in the European Union – Challenges and Policy Responses, Copenhagen: World Health Organization.Google Scholar
Tribunal de Contas (2011), Audit to Infarmed – The National Authority for Medicines and Health Products, Lisbon: Portuguese Court of Audit. (in Portuguese).Google Scholar
Wagstaff, A. (2002), ‘Poverty and health sector inequalities’, Bulletin of the World Health Organization, 80(2): 97–105.Google ScholarPubMed
Wagstaff, A. and van Doorslaer, E. (1992), ‘Equity in the finance of health care: some international comparisons’, Journal of Health Economics, 11: 361–387.CrossRefGoogle ScholarPubMed
Wagstaff, A., van Doorslaer, E., van der Burg, H., S. Calonge, T. Christiansen, G. Citoni, U.-G. Gerdtham, M. Gerfin, L. Gross, U. Hakinnen, P. Johnson, J. John, J. Klavus, C. Lauchaud, J. Lauritsen, R. Leu, B. Nolan, E. Perán, J. Pereira, C. Propper, F. Puffer, L. Rochaix, M. Rodríguez, M. Schellhorn, G. Sundberg and O. Winkelhake (1999), ‘Equity in the finance of health care: some further international comparisons’, Journal of Health Economics, 18: 263–290.CrossRefGoogle ScholarPubMed
World Health Organisation (WHO) (2000), World Health Report 2000: Health Systems: Improving Performance, Geneva: WHO.Google Scholar
World Health Organisation (WHO) (2002), World Health Report 2002: Reducing Risks, Promoting Healthy Life, Geneva: WHO.Google Scholar
World Health Organisation (WHO) (2009), The European Health Report 2009: Health and Health Systems, Copenhagen: WHO – Regional Office for Europe.Google Scholar
World Health Organisation (WHO) (2010), ‘Exploring the Thresholds of Health Expenditure for Protection Against Financial Risk’, World Health Report 2010, Background Paper No. 19, Geneva, WHO.Google Scholar
World Health Organisation (WHO) (2013), World Health Statistics, Geneva: WHO.Google Scholar
World Health Organisation (WHO) (2015), Physical Activity, Fact Sheet No. 385, Geneva, WHO.Google Scholar
Xu, K. (2005), Distribution of Health Payments and Catastrophic Expenditures: Methodology, Geneva: World Health Organization.Google Scholar
Xu, K., Evans, B., Carrin, G. and Aguilar-Rivera, A. M. (2005), ‘Designing Health Financing Systems to Reduce Catastrophic Health Expenditure’, Technical Briefs for Policy-Makers 2, Geneva, World Health Organization.Google Scholar
Xu, K., Evans, D., Kadama, P., Nabyonga, J., Ogwal, P. O., Nabukhonzo, P. and Aguilar, A. M. (2006), ‘Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda’, Social Science & Medicine, 62: 866–876.CrossRefGoogle ScholarPubMed
Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J. and Murray, C. J. (2003), ‘Household catastrophic health expenditure: a multicountry analysis’, Lancet, 362(9378): 111–117.CrossRefGoogle ScholarPubMed
Xu, K., Evans, D. B., Carrin, G., Aguilar, A. M., Musgrove, P. and Evans, T. (2007), ‘Protecting households from catastrophic health spending’, Health Affairs, 26(4): 972–983.CrossRefGoogle ScholarPubMed
Yardim, M. S., Cilingiroglu, N. and Yardim, N. (2010), ‘Catastrophic health expenditure and impoverishment in Turkey’, Health Policy, 94: 26–33.CrossRefGoogle ScholarPubMed