Financial protection from health care spending in Argentina: evolution and distribution (1985-2018)

INTRODUCTION: Financial protection from healthcare spending has become an important objective to be addressed by health systems all over the world. A common strategy used to assess financial protection from health care is to estimate the proportion of the population for which out-of-pocket expenditures made at the moment of receiving health services (OOP) might affect the consumption of other goods and services. To this end, two groups of indicators have been developed: catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE).  This work aims to investigate how CHE and IHE evolved in Argentina and how equitable was distributed between 1985 and 2018. METHODOLOGY: we estimated CHE and IHE measures, concentration indexes and concentration curves for all studied periods. In addition, we performed dominance analysis of concentration curves in order to assess changes in the distribution of CHE.  RESULTS: In 2017/18, 9.57 % of Argentina’s population incurred in CHE using a 10 % of total expenditure (EXP) threshold, 5.81 % using a 15 % of EXP, 4.52 % using a 25 % of EXP net of food spending (ATP), and 1.87 % using a 40 % of ATP. All CHE headcount measures dropped considerably between 1996/97 and 2017/18. IHE measures resulted in nearly zero values. The distribution of CHE was found to be progressive in all periods applying different thresholds. Dominance analysis and CI show that 2004/05 was the most progressive period. However, dominance between curves was only found using low specificity criteria. DISCUSSION: We found evidence of higher financial protection in the most recent studied period and progressivity of CHE in all periods. A further question to be assessed is whether the lower CHE and progressivity in its distribution is a consequence of an effective public policy or difficulties to access health care.