Decomposition of socioeconomic inequalities in catastrophic out-of-pocket expenditure for healthcare in Canada.

Hajizadeh, M; Pandey, S; Pulok, MH

Decomposition of socioeconomic inequalities in catastrophic out-of-pocket expenditure for healthcare in Canada.

Hajizadeh, M Pandey, S Pulok, MH

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Health Policy, 2023, 127, pp. 51-59
Issue Date:: 2023-01

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Field	Value	Language
dc.contributor.author	Hajizadeh, M
dc.contributor.author	Pandey, S
dc.contributor.author	Pulok, MH
dc.date.accessioned	2024-04-21T01:23:44Z
dc.date.available	2022-12-09
dc.date.available	2024-04-21T01:23:44Z
dc.date.issued	2023-01
dc.identifier.citation	Health Policy, 2023, 127, pp. 51-59
dc.identifier.issn	0168-8510
dc.identifier.issn	1872-6054
dc.identifier.uri	http://hdl.handle.net/10453/178124
dc.description.abstract	Despite a publicly financed health system for physician and hospital services, out-of-pocket health expenditure (OHE) accounts for a significant proportion of healthcare financing in Canada. We pooled annual Surveys of Household Spending conducted from 2010 to 2017 (n=34,105) to estimate the catastrophic out-of-pocket expenditure (COHE) burden using two definitions: the budget share (OHE exceeding 10% of a household's total consumption) and capacity-to-pay (OHE exceeding 40% of a household's total consumption minus basic subsistence needs). The Wagstaff index (WI) and the Erreygers Index (EI) were used to quantify and decompose socioeconomic inequalities in COHE. Results demonstrate that approximately 6% and 10% of the households faced COHE in Canada, depending on whether we used the budget share or capacity-to-pay approach to measure COHE. The COHE was found to be concentrated among low socioeconomic status (SES) households. Decomposition results indicate that besides SES, household characteristics (e.g., households headed by females and the presence of senior(s) in the households) were the most important factors contributing to the concentration of COHE among the poorer households. The lower utilization of healthcare services among the poor resulted in reduced COHE among these households. A higher burden of COHE is a major concern in Canada. Policies to enhance risk protection among specific populations such as the seniors are required to improve equity in healthcare financing in Canada.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Health Policy
dc.relation.isbasedon	10.1016/j.healthpol.2022.12.005
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1605 Policy and Administration
dc.subject.classification	Health Policy & Services
dc.subject.classification	4206 Public health
dc.subject.classification	4407 Policy and administration
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Health Expenditures
dc.subject.mesh	Delivery of Health Care
dc.subject.mesh	Family Characteristics
dc.subject.mesh	Low Socioeconomic Status
dc.subject.mesh	Canada
dc.subject.mesh	Catastrophic Illness
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Humans
dc.subject.mesh	Catastrophic Illness
dc.subject.mesh	Family Characteristics
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Health Expenditures
dc.subject.mesh	Delivery of Health Care
dc.subject.mesh	Canada
dc.subject.mesh	Female
dc.subject.mesh	Low Socioeconomic Status
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Health Expenditures
dc.subject.mesh	Delivery of Health Care
dc.subject.mesh	Family Characteristics
dc.subject.mesh	Low Socioeconomic Status
dc.subject.mesh	Canada
dc.subject.mesh	Catastrophic Illness
dc.subject.mesh	Socioeconomic Factors
dc.title	Decomposition of socioeconomic inequalities in catastrophic out-of-pocket expenditure for healthcare in Canada.
dc.type	Journal Article
utslib.citation.volume	127
utslib.location.activity	Ireland
utslib.for	1117 Public Health and Health Services
utslib.for	1605 Policy and Administration
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/DVC (International)
utslib.copyright.status	closed_access	*
dc.date.updated	2024-04-21T01:23:38Z
pubs.publication-status	Published
pubs.volume	127

Abstract:

Despite a publicly financed health system for physician and hospital services, out-of-pocket health expenditure (OHE) accounts for a significant proportion of healthcare financing in Canada. We pooled annual Surveys of Household Spending conducted from 2010 to 2017 (n=34,105) to estimate the catastrophic out-of-pocket expenditure (COHE) burden using two definitions: the budget share (OHE exceeding 10% of a household's total consumption) and capacity-to-pay (OHE exceeding 40% of a household's total consumption minus basic subsistence needs). The Wagstaff index (WI) and the Erreygers Index (EI) were used to quantify and decompose socioeconomic inequalities in COHE. Results demonstrate that approximately 6% and 10% of the households faced COHE in Canada, depending on whether we used the budget share or capacity-to-pay approach to measure COHE. The COHE was found to be concentrated among low socioeconomic status (SES) households. Decomposition results indicate that besides SES, household characteristics (e.g., households headed by females and the presence of senior(s) in the households) were the most important factors contributing to the concentration of COHE among the poorer households. The lower utilization of healthcare services among the poor resulted in reduced COHE among these households. A higher burden of COHE is a major concern in Canada. Policies to enhance risk protection among specific populations such as the seniors are required to improve equity in healthcare financing in Canada.

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http://hdl.handle.net/10453/178124