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; therefore, 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, analysing 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. The data of this work come from the Portuguese Household Budget Survey 2015/2016 and the study includes 11,398 observations. The WHO methodology for CHE identification was adopted. Over one fifth of the households incurring CHE spent money only on medicines, and this presented, by far, the highest expenditures. All families with CHE spent money 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.