Out-of-Pocket Expenditures on Health: A Global Stocktake

38 Pages Posted: 9 Apr 2019

See all articles by Adam Wagstaff

Adam Wagstaff

World Bank - Development Research Group (DECRG)

Patrick Hoang-Vu Eozenou

World Bank

Marc-Francois Smitz

World Bank

Date Written: April 8, 2019

Abstract

This paper provides an overview of research on out-of-pocket health expenditures, reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of gross domestic product spent on health. The two measures of dispersion or risk -- the coefficient of variation and Q90/Q50 -- are only weakly correlated across countries and not explained by the macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of "catastrophic" expenditures. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.

Keywords: Health Care Services Industry, Inequality, Health Economics & Finance, Labor & Employment Law

Suggested Citation

Wagstaff, Adam and Eozenou, Patrick Hoang-Vu and Smitz, Marc-Francois, Out-of-Pocket Expenditures on Health: A Global Stocktake (April 8, 2019). World Bank Policy Research Working Paper No. 8808. Available at SSRN: https://ssrn.com/abstract=3368582

Adam Wagstaff (Contact Author)

World Bank - Development Research Group (DECRG) ( email )

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

HOME PAGE: http://econ.worldbank.org/staff/awagstaff

Patrick Hoang-Vu Eozenou

World Bank

1818 H Street, NW
Washington, DC 20433
United States

Marc-Francois Smitz

World Bank

1818 H Street, NW
Washington, DC 20433
United States

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