Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #107230

Laurel E. Hatt, MPH, Bloomberg School of Public Health, Department of International Health, Johns Hopkins University, 1506 D Street, SE, Washington, DC 20003, 202-543-4715, lhatt@jhsph.edu

In 2000, the World Health Organization stated that financial protection from catastrophic health spending should be one of the primary goals of health systems. Health care spending is a significant cause of poverty worldwide, and the poor are often more vulnerable to catastrophic payments. However, little work has been done to define and measure catastrophic health expenditures in developing countries, or to evaluate how they affect household welfare over time. An important context in which to investigate this problem is in Peru, which has among the highest rates of catastrophic health spending in the world. In this paper, I will analyze cross-sectional and longitudinal data from the Peru National Survey of Households (ENAHO) for the years 1998-2002. Adapting previous WHO indicators, I define two binary catastrophic expenditure indicators: health expenditures that exceed 10% of total household spending, and health expenditures that exceed 20% of non-food household spending. Using logistic regression, I describe the distribution of catastrophic expenditures in Peru and identify associated risk factors, comparing the two indicators. I then use longitudinal linear regression to measure the effects of a catastrophic health payment on total household spending, food spending, and debt payments over time. A fixed-effects model is specified to remove potential endogeneity bias. The results of this research will help policymakers in Peru assess the magnitude of the problem, identify risk factors that can be used to target vulnerable populations, and evaluate whether existing catastrophic expenditure indicators effectively predict decreases in household welfare over time.

Learning Objectives:

• Define two indicators of catastrophic health spending
• Identify five potential risk factors for catastrophic health expenditures in a developing country setting
• Describe methods for analyzing catastrophic expenditures using longitudinal data

Keywords: Developing Countries, Economic Analysis

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation