ArticleThe Lancet. Global health2023
Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis.
Article in The Lancet. Global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- COVID-19 pandemic response in South American countries: lessons learned and recommendations for health strengthening.Revista peruana de medicina experimental y salud publica · 2026Review
- Out-of-pocket health expenditures and financial protection in Türkiye: pre-pandemic (2019) and COVID-19 era (2022) microdata.BMC health services research · 2026Article
- Understanding the financial hardships faced by TB and HIV patients during the COVID-19 pandemic: a mixed-method study in Bandung and Yogyakarta, Indonesia.Health policy and planning · 2025Article
- Awareness and Sociodemographic Factors as Predictors of Knowledge About Health Economics and Pharmacoeconomics Among Registered Nurses: A Cross-Sectional Study.ClinicoEconomics and outcomes research : CEOR · 2025Article
- Article
- How do Chinese people perceive their healthcare system? Inequality in public satisfaction with healthcare security.Frontiers in public health · 2025Article
- The COVID-19 Pandemic Economic Implications in Iran: A National Survey Assessing Catastrophic Health Expenditures.Interdisciplinary perspectives on infectious diseases · 2025Article
- Assessment of the COVID-19 impact on the Brazilian Unified Health System (SUS) financing: an analysis of the financing dynamics of 2020 and 2021.BMC health services research · 2024Article
- Persistency of catastrophic out-of-pocket health expenditures: Measurement with evidence from three African countries - Malawi, Tanzania, and Uganda.Social science & medicine (1982) · 2024Article
- Evidence of health system resilience in primary health care for preventing under-five mortality in Rwanda and Bangladesh: Lessons from an implementation study during the Millennium Development Goal period and the early period of COVID-19.Journal of global health · 2024Article
- Utilisation, out-of-pocket payments and access before and after COVID-19: Thailand's Universal Health Coverage Scheme.BMJ global health · 2024Review
- An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021.Scientific reports · 2024Article
- Out-of-pocket healthcare expenditure in emerging economies: Evidence from panel data analysis.The journal of medicine accessArticle
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15 authors.
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Abstract
backgroundThe 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.
methodsIn 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).
findingsIn Mexico, CHE increased to 5·6% (95% uncertainty interval [UI] 5·1-6·2) in 2020, higher than predicted (3·2%, 2·5-4·0). In Belarus, CHE was 13·5% (11·8-15·2) in 2020, also higher than predicted (9·7%, 7·7-11·3). 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 4·6 (2·6-6·5) percentage points in Mexico and by 48·3 (40·6-56·0) percentage points in Peru, and the private share of health-care visits increased by 7·3 (4·3-10·3) percentage points in Mexico and by 20·7 (17·3-24·0) percentage points in Peru.
interpretationIn 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.
fundingThe Bill & Melinda Gates Foundation.
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