Catastrophic Expenditure on Medicines: An Analysis Based on the Portuguese Household Budget Survey 2015/2016

Financial protection is a core dimension of health system evaluation and several works on catastrophic health expenditure (CHE) have been developed. There are however some gaps in the literature, hence, this work aims to look at CHE from a different angle, following the money spent by households. The objectives are to identify how many and which health services are driving CHE and analyse the profile of households with CHE. Data come from the Portuguese Household Budget Survey 2015/2016 and the study includes 11,398 observations. WHO methodology for CHE identification was adopted. Over a fifth of households incurring CHE spent only on medicines and this item presented by far the highest expenditures. All families with CHE spent on medicines and about two thirds spent on up to three items. Expenditures on medical devices and hospital services were low. Dental care expenditures tended to assume extreme values. Although primary care services are spread across the country, expenditures on GP services were not at all negligible. The typical household with CHE consists of an old poor person living alone. Exempting these people from medicine co-payments is crucial to prevent catastrophic expenditure.