ArticleHealth policy and planning2023
Catastrophic health care expenditure and impoverishment in Bhutan.
Article in Health policy and planning, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Catastrophic health expenditure and associated factors in low-, lower-middle and upper-middle-income countries: systematic review and meta-analysis.Global health action · 2026Pooled it
- Catastrophic health expenditures associated with single admission for paediatric surgery in a low-resource setting: a multicentre study.BMJ global health · 2026Article
- Quality as part of universal health coverage in Bhutan: a narrative synthesis.The Lancet regional health. Southeast Asia · 2026Review
- One size does not fit all: income-sensitive thresholds for catastrophic health expenditure.Health policy and planning · 2026Article
- Determinants of catastrophic health expenditure: Evidence from a patient survey at public hospitals in the Northern midlands and mountainous areas, Vietnam.Journal of public health research · 2026Article
- Catastrophic health expenditure and commercial health insurance purchase: evidence from China.BMC health services research · 2026Article
- Prevalence and Intensity of Catastrophic Health Expenditure Among Residents in a Multiethnic Province in China: Cross-Sectional Study.JMIR public health and surveillance · 2025Article
- Multidimensional poverty and health: an analysis of multidimensional poverty and its influencing factors among rural residents in Western China from a health ecology perspective.BMJ global health · 2025Article
- Financial risk protection from vaccines in 52 Gavi-eligible low- and middle-income countries: A modeling study.PLoS medicine · 2025Article
- Out-of-pocket cost and financial catastrophe of patients with cancer: the alarming cost-of-illness in Bangladesh.International journal for equity in health · 2025Article
- Spatio-temporal patterns and determinants of persistent catastrophic health expenditure in China: evidence from the China Family Panel Studies.Frontiers in public health · 2025Article
- Consumer Financial Protection Versus Catastrophic Healthcare Expenditure in Zambia.Public health challenges · 2024Article
- Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies.Public health challenges · 2024Article
- Magnitude of health expenditure induced removable poverty in India: Some reflections of Ayushman Bharat.Heliyon · 2024Article
- Out-of-pocket expenditure among patients with diabetes in Bangladesh: A nation-wide population-based study.Health policy OPEN · 2023Article
- Cervical Cancer HPV Vaccination and Bhutan.South Asian journal of cancer · 2023Article
- Effects of multimorbidity patterns and socioeconomic status on catastrophic health expenditure of widowed older adults in China.Frontiers in public health · 2023Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Monitoring financial hardship due to out-of-pocket spending on health care is a critical determinant of progress towards universal health coverage. This study investigates the occurrence, intensity and determinants of catastrophic health expenditure and impoverishment in Bhutan using three rounds of the cross-sectional Bhutan Living Standard Surveys carried out in 2007, 2012 and 2017. We use a composite financial hardship measure defined as households experiencing either catastrophic health expenditure or impoverished/further impoverished due to health spending or both. We calculated concentration indices to examine socio-economic inequalities. We used logistic regression to examine the factors associated with financial hardship. We find that, in the context of a significant increase in living standards, there is a sharp increase in the incidence of catastrophic health expenditure (using 40% of capacity to pay) and impoverishment (based on equivalized average food-share-based poverty line) between 2007 and 2017. In 2017, catastrophic health expenditure was estimated at 0.51%, impoverishment at 0.32% and further impoverishment at 1.93% of the population, cumulating to financial hardship affecting 2.55% of the population. Financial hardship particularly burdened rural dwellers and poorer households. Transportation costs almost doubled the risk of facing financial hardship. Households that were poor, had an unemployed head, were larger and had more elderly members had higher odds of financial hardship. This evidence should prompt policy and programmatic interventions to support Bhutan's progress towards universal health coverage.
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