Health system

The proportion of the population with household expenditure on health exceeding 10% of total household expenditure or income.

Catastrophic health spending, Financial hardship, Financial protection, Out-of-pocket health expenditure

Global, regional, national, place of residence (rural, urban), household age or sex, age composition of household

Impact

Health expenditures are likely to expose households to financial hardship, in particular when they exceed a pre-defined threshold of a household’s ability to pay. When this happens, they are characterized as being catastrophic. Within the SDG monitoring framework (SDG indicator 3.8.2), the proportion of the population facing catastrophic expenditures is measured as the population-weighted average of the number of households with “large household expenditures on health” as a share of total household expenditure or income (household’s budget). Large is defined as health expenditures exceeding 10% or 25% of total household expenditure or income. The household’s sample weight multiplied by the household size is used to obtain representative numbers per person. If the sample is self-weighting, then only the household size is used as the weight. Household expenditures on health are defined as formal and informal payments made at the time of getting any type of care (promotive, curative, rehabilitative, palliative or long-term care) provided by any type of provider. These payments include the part not covered by a third party such as the government, health insurance fund or private insurance but exclude insurance premiums as well as any reimbursement by a third party. They might be financed by income, including remittance, savings or borrowings. With this definition, health expenditures are labelled Out-Of-Pocket (OOP) payments in the classification of health care financing schemes (HF) of the International Classification for Health Accounts (ICHA). The population with household health expenditures greater than 10% of total household expenditure or income (SDG indicator 3.8.2) can be disaggregated as follows if the survey has been designed to provide representative estimates and/or there were enough observations at such levels: “rural” and “urban”; sex of the head of the household (male/female); age of the head of the household (below 60 years old/ 60 years or older); age composition of the household: “Adults only (20-59 years old)” - households that consist of members aged between 20 and 59 years old; “Adults with children and adolescents (below 60 years old members)” - households that consist of members aged below 60 only as follows: at least one member below 20 years old AND at least one member aged between 20 and 59 years old; “Multigenerational households (all ages)” - households that include at least one person below 20 years old AND at least one person aged between 20 and 59 years old AND at least one person >= 60 years old; “Adults with older persons (from 20 years old)” - households that consist of members aged >=20 only as follows: at least one person aged between 20 and 59 years old AND at least one person >= 60 years old; “Only older adults (>=60 years old)” - households that consist of members aged >=60 years old only; “Only members below 20 years old” - households that consist of members aged below 20 years old only. In this classification, children are defined as those aged below 10 years, adolescents are those between 10 and 19 years old, and older persons/adults are at least 60 years old. Other types of disaggregation are possible, for example, by quintiles of the household welfare measures (total household consumption expenditure or income). To fully understand progress towards UHC within the SDG monitoring framework, SDG indicator 3.8.2 should be monitored jointly with SDG indicator 3.8.1 on coverage of essential health services. Other definitions than the one used for SDG 3.8.2 can be used to monitor catastrophic health spending, and they are also part of WHO regional monitoring frameworks. Other definitions than the one used for SDG 3.8.2 can be used to monitor catastrophic health spending, and they are also part of WHO regional monitoring frameworks.

The global and regional incidence of the proportion of the population with household expenditures on health greater than 10% of total household expenditure or income is estimated as the population-weighted average of the country-level share of people with such catastrophic health expenditures (SDG 3.8.2, 10% threshold) for a reference year. Incidence at the country level for the reference year is estimated using different methods depending upon the availability of information for that country around or at the reference year (T*). In countries for which there is an observed incidence rate of the SDG indicator 3.8.2 at the 10% threshold in the reference year T*, this point is used. When there are at least two observed incidence rates of the SDG indicator 3.8.2 at the 10% threshold around the reference over a 5-year window [T*–5; T*+5], linear interpolation is used to project the value of the proportion of “the population with household expenditures on health greater than 10% of total household expenditure or income” in the reference year. If these conditions are not met but there is at least one observed incidence rate of the SDG indicator 3.8.2 at the 10% threshold, a multilevel model of the rate of catastrophic payments (SDG indicator 3.8.2, 10% threshold) is estimated using the aggregate share of OOP over total consumption expenditure as the explanatory variable if that information is available. If such information is not available or there isn’t a single incidence rate of the SDG indicator 3.8.2 at the 10% threshold, it is imputed in the reference year with the median rate in that year among countries within the same income group (low, lower-middle, upper-middle, or high) as classified by the World Bank. If such classification is missing, the regional median value of the SDG indicator 3.8.2 at the 10% threshold is used. The regional classification used for the imputation is M49 level 1. The country estimates for the reference year are then aggregated up to the regional and global levels to compute the “Total population with household expenditures on health greater than 10% of total household income or expenditure” in millions. The proportion of the total population at the global and regional levels is then calculated by expressing these numbers as a share of the relevant population, equivalent to taking a population-weighted average of the relevant country rates.

Every 2-3 years

Every 1–5 years, depending on the implementation of population-based household expenditure surveys led by national statistics offices

uhc_stats@who.int

Dr. Gabriela Flores