ArticleHealth economics review2022
Which indicator should be used? A comparison between the incidence and intensity of catastrophic health expenditure: using difference-in-difference analysis.
Article in Health economics review, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Economic burden of typhoid among hospitalised children in Kenya.BMJ global health · 2026Article
- Machine learning based classification of catastrophic health expenditures: a cross-sectional study of Korean low-income households.BMC health services research · 2025Article
- The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review.Health promotion international · 2024Article
- Impact of Medical-Pharmaceutical Separation Reform on Hospitalization Expenditure in Tertiary Public Hospitals: Difference-in-Difference Analysis Based on Panel Data from Beijing.Risk management and healthcare policy · 2024Article
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Abstract
backgroundCatastrophic health expenditure (CHE) represents out-of-pocket payment as a share of household income. Most previous studies have focused on incidence aspects when assessing health policy effects. However, because CHE incidence is a binary variable, the effect of the health policy could not accurately be evaluated. On the contrary, the intensity of CHE is a continuous variable that can yield completely different results from previous studies. This study reassesses the coverage expansion plan for four serious diseases using the intensity of CHE in Korea.
methodsWe used the Korea Health Panel Study from 2013 to 2015 to conduct the analysis. The study population is households with chronic diseases patients. We divided the population into two groups: the policy beneficiary group, i.e., households with a patient of any of the four serious diseases, and the non-beneficiary group. A difference-in-difference model was employed to compare the variation in the intensity and incidence of CHE between the two groups. We defined the incidence of CHE as when the ratio of out-of-pocket medical expenses to household income is more than a threshold of 10%, and the intensity of CHE is the height of the ratio subtracting the threshold 10%.
resultsThe increased rate of CHE intensity in households with four serious diseases was lower than that in households with other chronic diseases. The interaction term, which represents the effect of the policy, has a significant impact on the intensity but not on the incidence of CHE.
conclusionsCHE indicators should be applied differently according to the purpose of policy evaluation. The incidence of CHE should be used as the final achievement indicator, and the intensity of CHE should be used as the process indicator. Furthermore, because CHE has an inherent characteristic that is measured by the ratio of household income to medical expenses, to lower this, a differential out-of-pocket maximum policy for each income class is more appropriate than a policy for strengthening the coverage for specific diseases.
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