Health Care Use and Financial Burden of Out-of-Pocket Spending in Argentina

One of the major challenges for health systems is to ensure that everybody has access to needed care without facing catastrophic payments or impoverishment. Argentina is middle income country that has experienced remarkable transformations in income distribution and inequality in the last decade. The health sector as the rest of the economy has suffered from the deterioration of the living conditions during the last years of the 1990s, ending up in an economic crisis at the end of 2001. Objectives: This paper aims at identifying the impact of these changes, mainly between 1997 and 2002, on access to health services and on financial risk protection across population, in particular of vulnerable groups. Methodology: Data used in this study come from three different surveys, namely National Survey on Household Expenditure 1996/1997, Conditions of Life Survey 1997 and World Bank Survey 2002. All surveys are nationally representative. Multinomial Logit regression model has been used to explore the determinants of health service utilization and Logit regression model for determinants of catastrophic health expenditure. Financial catastrophe is defined as out-of-pocket expenditure for health equal to or exceeding 40% of total household non-subsistence spending. Results: Insurance coverage decreased from 63% in 1997 to 56% in 2002. Health care utilization is clearly linked to income. Richer individuals are more likely to use both social health insurance and private health facilities and are less likely to use public facilities, which may indicate that the perception of poor quality of care in public health facilities leads people to turn to private health care as soon as they can afford it. For those who had used health services, the required out-of-pocket payments placed a heavy burden to households. The level of catastrophic expenditure has diminished from 1997 (5.5%) to 2002 (3.6%). One reason could be the reduction in the use of health care for low and low-middle income households. The study identifies good reasons to believe that households with elderly members are the most likely to face financial difficulties due to out-of-pocket payments. Neither in 1997 nor in 2002 there is evidence that households covered by social health insurance are less likely to face catastrophic expenditure. The low-middle income groups appears to have high proportion of household with catastrophic expenditure in both years. Conclusions: In summary, the required out-of-pocket payments for health care in Argentina result in some household facing financial catastrophe, some household being pushed into poverty and some others forwent needed care. Therefore, special attention should be paid to the elderly population and to improvements in the quality of public facilities and in the extension of the social health insurance coverage and its degree of financial protection, specially for low and middle-low income groups..