Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis

Background The COVID-19 pandemic disrupted health systems in 2020, but it is unclear how financial hardship due to out-of-pocket (OOP) health-care costs was affected. We analysed catastrophic health expenditure (CHE) in 2020 in five countries with available household expenditure data: Belarus, Mexico, Peru, Russia, and Viet Nam. In Mexico and Peru, we also conducted an analysis of drivers of change in CHE in 2020 using publicly available data.Methods In this time-series analysis, we defined CHE as when OOP health-care spending exceeds 10% of consumption expenditure. Data for 2004-20 were obtained from individual and household level survey microdata (available for Mexico and Peru only), and tabulated data from the National Statistical Committee of Belarus and the World Bank Health Equity and Financial Protection Indicator database (for Viet Nam and Russia). We compared 2020 CHE with the CHE predicted from historical trends using an ensemble model. This method was also used to assess drivers of CHE: insurance coverage, OOP expenditure, and consumption expenditure. Interrupted time-series analysis was used to investigate the role of stay-at-home orders in March, 2020 in changes in health-care use and sector (ie, private vs public).Findings In Mexico, CHE increased to 5 center dot 6% (95% uncertainty interval [UI] 5 center dot 1-6 center dot 2) in 2020, higher than predicted (3 center dot 2%, 2 center dot 5-4 center dot 0). In Belarus, CHE was 13 center dot 5% (11 center dot 8-15 center dot 2) in 2020, also higher than predicted (9 center dot 7%, 7 center dot 7-11 center dot 3). CHE was not different than predicted by past trends in Russia, Peru, and Viet Nam. Between March and April, 2020, health-care visits dropped by 4 center dot 6 (2 center dot 6-6 center dot 5) percentage points in Mexico and by 48 center dot 3 (40 center dot 6-56 center dot 0) percentage points in Peru, and the private share of health-care visits increased by 7 center dot 3 (4 center dot 3-10 center dot 3) percentage points in Mexico and by 20 center dot 7 (17 center dot 3-24 center dot 0) percentage points in Peru.Interpretation In three of the five countries studied, health systems either did not protect people from the financial risks of health care or did not maintain health-care access in 2020, an indication of health systems failing to maintain basic functions. If the 2020 response to the COVID-19 pandemic accelerated shifts to private health-care use, policies to cover costs in that sector or motivate patients to return to the public sector are needed to maintain financial risk protection.Funding The Bill & Melinda Gates Foundation. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Automated summary

The study examines the catastrophic health expenditure in five countries during the COVID-19 pandemic. It highlights the financial burden caused by out-of-pocket health-care costs and the need to protect individuals from the risks of health care while maintaining access to essential services.