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Catastrophic healthcare payments and impoverishment in the occupied Palestinian territory

Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

Financial protection from the risks of ill health has globally recognized importance as a principal performance goal of any health system. This type of financial protection involves minimizing catastrophic payments for healthcare and their associated impoverishing effects. Realization of this performance goal is heavily influenced by factors related to the overall policy environment and sociopolitical context in each country.

Objectives

To examine the incidence and intensity of catastrophic and impoverishing healthcare payments borne by Palestinian households between 1998 and 2007. The incidence and intensity of these effects are examined within the historically unique policy and socioeconomic context of the occupied Palestinian territory.

Methods

A healthcare payment was considered catastrophic if it exceeded 10% of household resources, or 40% of resources net of food expenditures. The impoverishing effect of healthcare was examined by comparing poverty incidence and intensity before and after healthcare payments. The data source was a series of annual expenditure and consumption surveys covering 1998 and 2004–7, and including representative samples of Palestinian households (n = 1231–3098, per year). Total household expenditure was used as a proxy for household level of resources; and the sum of household expenses on a comprehensive list of medical goods and services was used to estimate healthcare payments.

Results

While only around 1% of the surveyed households spent ≥40% of their total household expenditures (net of food expenses) on healthcare in 1998, the percentage was almost doubled in 2007. In terms of impoverishing effect, while 11.8% of surveyed households fell into deep poverty in 1998 due to healthcare payments, 12.5% of households entered deep poverty for the same reason in 2006. Over the same period, the monthly amount by which poor households failed to reach the deep poverty line due to healthcare payments increased from $US9.4 to $US12.9.

Conclusions

The inability of the Palestinian healthcare system to protect against the financial risks of ill health could be attributed to the prevailing sociopolitical conditions of the occupied Palestinian territory, and to some intrinsic system characteristics. It is recommended that pro-poor financing schemes be pursued to mitigate the negative impact of the recurrent health shocks affecting Palestinian households.

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References

  1. Commission on Social Determinants of Health [WHO/WIP/EQH/OI/2006]. Geneva: WHO, 2006 [online]. Available from URL: http://www.who.int/social_determinants/resources/csdh_brochure.pdf [Accessed 2009 Apr 18]

  2. Gilson L, Doherty J, Loewenson R, et al. Challenging inequity through health systems: final report. Knowledge Network on Health Systems. WHO Commission on the Social Determinants of Health. Geneva: WHO, 2007 Jun

    Google Scholar 

  3. McKee M. Measuring the efficiency of health systems: the world health report sets the agenda, but there’s still a long way to go. BMJ 2001; 323(7308): 295–6

    Article  PubMed  CAS  Google Scholar 

  4. WHO. World health report 2000. Health systems: improving performance. Geneva: WHO, 2000

    Google Scholar 

  5. O’Donnell O, van Doorslaer E, Wagstaff A, et al. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, DC: The World Bank, 2008 [online]. Available from URL: http://siteresources.worldbank.org/INTPAH/Resources/Publications/459843-1195594469249/HealthEquityFINAL.pdf [Accessed 2010 Sep 26]

    Google Scholar 

  6. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: WHO, 2008 [online]. Available from URL: http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf [Accessed 2010 Sep 26]

    Google Scholar 

  7. Wagstaff A, van Doorslaer E. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Econ 2003; 12(11): 921–34

    Article  PubMed  Google Scholar 

  8. Kakwani N. Measurement of tax progressivity: an international comparison. Econ J 1977; 87(345): 71–80

    Article  Google Scholar 

  9. Reynolds M, Smolensky E. Public expenditures, taxes, and the distribution of income: the United States, 1950–1970. New York: Academic Press, 1977

    Google Scholar 

  10. O’Donnell O, van Doorslaer E, Rannan-Eliya RP, et al. Who pays for health care in Asia? J Health Econ 2008; 27(2): 460–75

    Article  PubMed  Google Scholar 

  11. Xu K, Evans DB, Kawabata K, et al. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003; 362(9378): 111–7

    Article  PubMed  Google Scholar 

  12. van Doorslaer E, O’Donnell O, Rannan-Eliya RP, et al. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet 2006; 368(9544): 1357–64

    Article  PubMed  Google Scholar 

  13. Limwattananon S, Tangcharoensathien V, Prakongsai P. Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bull World Health Organ 2007; 85(8): 600–6

    Article  PubMed  Google Scholar 

  14. Russell S. The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. Am J Trop Med Hyg 2004; 71(2 Suppl.): 147–55

    PubMed  Google Scholar 

  15. Mataria A, Khatib R, Donaldson C, et al. The health-care system: an assessment and reform agenda. Lancet 2009; 373(9670): 1207–17

    Article  PubMed  Google Scholar 

  16. Rahim HF, Wick L, Halileh S, et al. Maternal and child health in the occupied Palestinian territory. Lancet 2009; 373(9667): 967–77

    Article  PubMed  Google Scholar 

  17. Giacaman R, Khatib R, Shabaneh L, et al. Health status and health services in the occupied Palestinian territory. Lancet 2009; 373(9666): 837–49

    Article  Google Scholar 

  18. Husseini A, Abu-Rmeileh NM, Mikki N, et al. Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory. Lancet 2009; 373(9668): 1041–9

    Article  PubMed  Google Scholar 

  19. Palestinian Central Bureau of Statistics. Palestine households consumption and expenditure survey 1998. Ramallah: PCBS, 1998

    Google Scholar 

  20. Palestinian Central Bureau of Statistics. Palestine households consumption and expenditure survey 2004. Ramallah: PCBS, 2004

    Google Scholar 

  21. Palestinian Central Bureau of Statistics. Palestine households consumption and expenditure survey 2005. Ramallah: PCBS, 2005

    Google Scholar 

  22. Palestinian Central Bureau of Statistics. Palestine households consumption and expenditure survey 2006. Ramallah: PCBS, 2006

    Google Scholar 

  23. Palestinian Central Bureau of Statistics. Palestine households consumption and expenditure survey 2007. Ramallah: PCBS, 2008. (Data on file)

    Google Scholar 

  24. Batniji R, Rabaia Y, Nguyen-Gillham V, et al. Health as human security in the occupied Palestinian territory. Lancet 2009; 373(9669): 1133–43

    Article  PubMed  Google Scholar 

  25. NSHP. National strategic health plan: medium term development plan (2008–2010). Palestine: Palestinian National Authority, Ministry of Health, 2008

    Google Scholar 

  26. Palestinian Central Bureau of Statistics. Health care providers and beneficiaries survey: 2005. Main findings. Ramallah: PCBS, 2006

    Google Scholar 

  27. World Bank. West Bank and Gaza: medium-term development strategy for the health sector. Washington, DC: World Bank, 1998

    Google Scholar 

  28. Department for International Development. West Bank and Gaza Health sector expenditure review, 2006. London: Department for International Development, 2006

    Google Scholar 

  29. Palestinian Central Bureau of Statistics. Households health expenditure survey 2004. Ramallah: PCBS, 2004

    Google Scholar 

  30. Abu-Zaineh M, Mataria A, Luchini S, et al. Equity in health care financing in the Palestinian context: the value-added of the disaggregate approach. Soc Sci Med 2008; 66(11): 2308–20

    Article  PubMed  Google Scholar 

  31. Giacaman R, Abdul-Rahim HF, Wick L. Health sector reform in the Occupied Palestinian Territories (OPT): targeting the forest or the trees? Health Policy Plan 2003; 18(1): 59–67

    Article  PubMed  Google Scholar 

  32. Hamdan M, Defever M, Abdeen Z. Organizing health care within political turmoil: the Palestinian case. Int J Health Plann Manage 2003; 18(1): 63–87

    Article  PubMed  Google Scholar 

  33. Mataria A, Khoury P. Public policies to enhance private sector competitiveness in providing tertiary health care in Palestine: assessment and recommendations. Ramallah: Palestine Economic Policy Research Institute (MAS), 2008

    Google Scholar 

  34. Palestinian Central Bureau of Statistics. Palestine in figures 2007. Ramallah: PCBS, 2008

    Google Scholar 

  35. Palestinian Central Bureau of Statistics. Poverty and living conditions in the Palestinian territory, 2007. Ramallah: PCBS, 2008

    Google Scholar 

  36. Pradhan M, Prescott N. Social risk management options for medical care in Indonesia. Health Econ 2002; 11(5): 431–46

    Article  PubMed  Google Scholar 

  37. Ranson MK. Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bull World Health Organ 2002; 80(8): 613–21

    PubMed  Google Scholar 

  38. United Nations Statistics Division. Classifications of individual consumption according to purpose (COICOP), 2002 [online]. Available from URL: http://unstats.un.org/unsd/cr/registry/regcst.asp?Cl=5&Lg=1 [Accessed 2010 Sep 26]

    Google Scholar 

  39. Deaton A, Grosh M. Consumption, in designing household survey questionnaires for developing countries: lessons from 15 years of living standards measurement study. In: Grosh M, Glewwe P, editors. Washington, DC: The World Bank, 2000

    Google Scholar 

  40. Yazbeck A. Attacking inequality in the health sector: a synthesis of evidence and tools. Washington, DC: The World Bank, 2009

    Book  Google Scholar 

  41. Palestinian Central Bureau of Statistics. Poverty in the Palestinian territory, 2005: main findings report. Ramallah: PCBS, 2006

    Google Scholar 

  42. Palestinian Central Bureau of Statistics. Poverty survey in the Palestinian territory, December 2003: main findings report. Ramallah: PCBS, 2004

    Google Scholar 

  43. WHO. Monitoring the health sector in the occupied Palestinian territory, series reports [online]. Available from URL: http://www.emro.who.int/palestine/index.asp?page=library&option=monitoring.WHO_monthly_monitoring [Accessed 2008 Jan 7]

  44. WHO. Access to health services for Palestinian people: case studies of five patients in critical conditions who died while waiting to exit the Gaza Strip. Geneva: WHO, 2008

    Google Scholar 

  45. Palestinian Central Bureau of Statistics. Poverty in the Palestinian territory, 2006: main findings report. Ramallah: PCBS, 2007

    Google Scholar 

  46. Abu-Zaineh M, Mataria A, Luchini S, et al. Equity in health care finance in Palestine: the triple effects revealed. J Health Econ 2009 Dec; 28(6): 1071–80

    Article  PubMed  Google Scholar 

  47. Commission on Macroeconomics and Health. Macroeconomics and health: investing in health for economic development. Geneva: WHO, 2001

    Google Scholar 

  48. Gertler P, Gruber J. Insuring consumption against illness. Am Econ Rev 2002; 92(1): 51–71

    Article  Google Scholar 

  49. Mataria A, Raad F. Analyzing health equity in the West Bank and Gaza. Washington, DC: The World Bank, 2009

    Google Scholar 

Download references

Acknowledgements

World Bank grant financing was provided to the West Bank and Gaza World Bank team working on the health sector to explore health equity issues. This article is based on the findings[49]

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Correspondence to Awad Mataria.

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Mataria, A., Raad, F., Abu-Zaineh, M. et al. Catastrophic healthcare payments and impoverishment in the occupied Palestinian territory. Appl Health Econ Health Policy 8, 393–405 (2010). https://doi.org/10.2165/11318200-000000000-00000

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