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Gasto de bolsillo y gasto catastrófico en salud en los hogares de Cartagena, Colombia
Out-of-pocket and catastrophic health expenditure in households of Cartagena, Colombia
DOI:
https://doi.org/10.15446/rsap.v20n5.61403Palabras clave:
Gastos en salud, equidad en salud (es)Health expenditures, health equity (en)
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Objetivo Estimar el gasto de bolsillo y la probabilidad de gasto catastrófico de los hogares y sus determinantes socioeconómicos en Cartagena, Colombia.
Materiales y Métodos Estudio transversal en una muestra poblacional estratificada aleatoria de hogares de Cartagena. Se estimaron dos modelos de regresión cuyas variables dependientes fueron gasto de bolsillo y probabilidad de gasto catastrófico en salud de los hogares.
Resultados El gasto de bolsillo promedio anual en hogares pobres fue 1 566 036 COP (US$783) (IC95% 1 117 597–2 014 475); en hogares de estrato medio 2 492 928 COP (US$1246) (IC95% 1 695 845-3 290 011) y en hogares ricos 4 577 172 COP (US$2 288) (IC95% 1 838 222-7 316 122). Como proporción del ingreso, el gasto de bolsillo en salud fue de 14,6% en los hogares pobres, de 8,2% en los hogares de estrato medio y de 7,0% en los hogares ricos. La probabilidad de gasto catastrófico en salud de los hogares pobres fue 30,6% (IC95% 25,6-35,5%), de los de estrato medio del 10,2% (IC95% 4,5-15,9%) y de los hogares de estrato alto del 8,6% (IC95% 1,8-23,0%). El estrato socioeconómico, la educación y la ocupación fueron los principales determinantes del gasto de bolsillo en salud y de la probabilidad de incurrir en gasto catastrófico en salud.
Conclusiones En el sistema de salud persisten desigualdades en la protección financiera de los hogares contra el gasto de bolsillo y la probabilidad de gasto catastrófico. El presente estudio genera evidencia para revisar la política de protección social de los hogares socioeconómicamente más vulnerables.
Objective To estimate out-of-pocket (OOP) health expenditure and the probability to incur in catastrophic health expenditure, as well as the socio-demographic determinants of households in Cartagena, Colombia.
Materials and Methods Population-based cross-sectional study on a randomized stratified sample of Cartagena households. Two regression models were developed using OOP health expenditure and the probability to incur in catastrophic health expenditure as dependent variables.
Results The average annual OOP health expenditure was $1 566 036 COP (US$783) (95%CI: $1 117 597 - $2 014 475) in poor households, $2 492 928 COP (US$1 246) (95%CI: $1 695 845 - $3 290 011) in middle class households, and $4 577 172 COP (US$2 288) (95%CI: $1 838 222 - $7 316 122) in upper class households. Regarding the household income ratio, the OOP health expenditure was 14.6% in poor households, 8.2% in middle class, and 7.0% in upper class households. The probability to incur in catastrophic health expenditure was 30.6% (95%CI: 25.6% - 35.5%), 10.2% (95%CI: 4.5%-15.9%) and 8.6% (95%CI: 1.8%-23%) in the low, middle- and high-class households, respectively. Educational attainment, socioeconomic strata and employment were the main determinants of OOP and the probability to incur in catastrophic health expenditure.
Conclusions The health system has persistent inequalities regarding the financial protection of households related to
out-of-pocket expenditure and the probability of catastrophic expenditure. This study provides evidence to review the
social protection policy for the most socio-economically vulnerable households.
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CrossRef Cited-by
1. Juan Luis Ramirez-Agudelo, Monica Pinilla-Roncancio, Dawit Wolde Daka. (2023). What are the factors associated with catastrophic health expenditure in Colombia? A multi-level analysis. PLOS ONE, 18(7), p.e0288973. https://doi.org/10.1371/journal.pone.0288973.
2. Valerie A. Luyckx, Ziyad Al-Aly, Aminu K. Bello, Ezequiel Bellorin-Font, Raul G. Carlini, June Fabian, Guillermo Garcia-Garcia, Arpana Iyengar, Mohammed Sekkarie, Wim van Biesen, Ifeoma Ulasi, Karen Yeates, John Stanifer. (2021). Sustainable Development Goals relevant to kidney health: an update on progress. Nature Reviews Nephrology, 17(1), p.15. https://doi.org/10.1038/s41581-020-00363-6.
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