Measuring Financial Protection in Health in Brazil: Catastrophic and Poverty Impacts of Health Care Payments Using the Latest National Household Consumption Survey

Abstract

This paper measures financial protection in health in Brazil by estimating the incidence and describes the profile of catastrophic expenditures and impoverishment due to household out-of-pocket (OOP) health spending. It uses the latest Brazilian consumption survey (POF 2017/2018) to analyze the composition of household health spending and applies two thresholds of household consumption to identify households facing catastrophic expenditures and impoverishment due to health care payments. Results show that a third of households spend more than 10% of their budget on health, and the share of households facing financial hardship is significantly higher among the Brazilian poor (37% among the bottom consumption deciles). Medicines are the main contributor to component of OOP health spending, reaching 85% of all OOP payments for the lowest consumption deciles. Households with women as household head and those with heads with more years of schooling have higher probability of incurring catastrophic health spending. Yearly, more than 10 million Brazilians are pushed into poverty due to OOP health care payments, which represents a larger percentage of individuals (4.87%) than reported globally (2.5%) or among Latin America and Caribbean countries (1.8%). Conclusions: Despite the achievements in implementing universal health coverage in Brazil, challenges remain to guarantee financial protection to its population (especially the Brazilian poor). Policies to expand access and affordability of essential medicines are key to improve financial protection in health in Brazil.

Keywords: OOP catastrophic health spending; financial protection in health; health care financing; Brazil health system; universal health coverage.