Knaul et al. (2011) found catastrophic health expenditure to range from 1.56 to 0.31% of
households in 2004, while out-of-pocket payments were above 25% of total health
expenditure (calculations based on Global Health Observatory Data Repository)2. Of total
out-of-pocket payments, 80% was related to the purchase of medicines and medical
consultations, and 7% to laboratory exams and procedures. Expenditure on
hospitalization was rare and did not produce catastrophic expenditure. Households that
produced catastrophic expenditure spent a greater share on medical consultations and
drugs than households with no catastrophic health expenditure. While catastrophic health
expenditure was found to be sensitive to the indicator used in the calculation, generally
households with elderly members were found to be at greater risk than those without.
Furthermore, households in the first quintile were found to be more vulnerable than those
from higher quintiles. Having children increased out-of-pocket expenditure, but not
catastrophic health expenditure. Waiting lists were found to be above 360 days in several
service areas across the health system and considered to have possibly induced out-ofpocket
payments for those households that could afford it.