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# <u>Table 2. Previous studies of out-of-pocket health expenditures</u>

|**Concept**|<br>**Multi-country studies**|**Global studies**|
|---|---|---|
|1<br>Expenditure in<br>absolute terms|Squires (2011) compares 12 OECD countries in terms of inter alia<br>per capita out-of-pocket expenditure in $US, using data from the<br>OECD’s Health Data database. He finds that Switzerland and the<br>US have the largest per capita out-of-pocket expenditures on health,<br>and France and the UK the smallest.|None|
|1<br>Dispersion (risk)|None|None|
|<br>3<br>Budget share|None|None|
|4<br>Progressivity|Wagstaff et al. (1992; 1999) report the progressivity of out-of-pocket<br>expenditures (and other financing sources) in 10 and 12 OECD<br>countries; the second study also analyzes trends. Out-of-pocket<br>expenditures emerge as regressive for all countries and years, except<br>in Spain in 1980, and the trend is towards greater regressiveness.|None|
|5<br>Catastrophic<br>expenditures|<br>Van Doorslaer et al. (2007) look at catastrophic spending in 10 Asian<br>territories. They find relatively low rates in Malaysia, Sri Lanka and<br>Thailand, and relatively high rates in China, Vietnam and<br>Bangladesh.|Xu et al. (2003; 2007) analyze catastrophic expenditures in 89<br>countries defining catastrophic as out-of-pocket expenditures<br>exceeding 40% of consumptionless a deduction for food costs. They<br>reported mean and median rates of catastrophic spending so defined<br>of 2.3% and 1.5% respectively.<br>Wagstaff et al. (2018b) report results for 133 countries across the<br>world, many for multiple years. They estimate the mean and median<br>catastrophic out-of-pocket payment rates at the 10% threshold to be<br>9.2% and 7.1%. They report a positive population-weighted median<br>annual rate of change of catastrophic payment incidence whatever<br>catastrophic paymentincidencemeasureis used.|
|6<br>Inequality in incidence<br>of catastrophic<br>expenditures|Van Doorslaer et al. (2007) look at the distribution by gross<br>consumption of those experiencing catastrophic payments in 10<br>Asian territories. For the most part, they find that catastrophic<br>spending is higher among the better off. Taiwan is the exception:<br>catastrophic spending is concentrated among the poor whatever the<br>threshold.|None|
|7<br>Impoverishment|Van Doorslaer et al. (2006) use data from 11 Asian economies to<br>‘gross’ and ‘net’ poverty headcounts and poverty gaps using the<br>World Bank’s dollar-a-day poverty line (as well as its $2-a-day<br>poverty line). They find that the dollar-a-day poverty headcount is,<br>on average, almost three percentage points higher after deducting<br>out-of-pocket spending from household consumption. In Bangladesh<br>and India, the difference is almost four percentage points. In<br>Malaysia and Sri Lanka, by contrast, the difference is just 0.1 and<br>0.3 percentage points respectively.<br>Alam et al. (2005) compare ‘gross’ and ‘net’ poverty headcounts in 10<br>countries in Eastern Europe and the Former Soviet Union using a<br>$2.15-a-day poverty line at 2000 prices and purchasing power<br>parities. Onaverage, out-of-pocket paymentsraise the poverty|Xu et al. (2007) analyze impoverishing out-of-pocket expenditures in<br>89 countries defining a household as poor if its consumption fell short<br>of an allowance for food costs.<sup>12</sup>They estimated that globally 1.7% of<br>the population fell into poverty so defined because of out-of-pocket<br>health spending, with 90% of those people living in low-income<br>countries.<br>Wagstaff et al. (2018c) report rates of impoverishment in 122<br>countries (many for several years) using the $1.90-a-day and $3.10-a-<br>day poverty lines as well as a relative poverty line equal to 50% of<br>median consumption. They find population-weighted median rates of<br>impoverishment of 1.86% at the $1.90-a-day line, 2.44% at the $3.10-<br>a-day line, and 1.83% at the relative poverty line. Across countries,<br>the population-weighted median annual rate of change of|