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Malaysian Journal of Medical Sciences
School of Medical Sciences, Universiti Sains Malaysia
ISSN: 1394-195X
Vol. 26, No. 1, 2019, pp. 15-43
Bioline Code: mj19003
Full paper language: English
Document type: Review Article
Document available free of charge

Malaysian Journal of Medical Sciences, Vol. 26, No. 1, 2019, pp. 15-43

 en Determinants of Household Catastrophic Health Expenditure: A Systematic Review
Azzani, Meram; Roslani, April Camilla & Su, Tin Tin


The World Health Organization estimates that annually 150 million people experience severe (catastrophic) financial difficulties as a result of healthcare payments. Therefore, a systematic review was carried out to identify the determinants of household catastrophic health expenditure (CHE) in low- to high-income countries around the world. Both electronic and manual searches were conducted. The main outcome of interest was the determinants of CHE due to healthcare payments. Thirty eight studies met the inclusion criteria for review. The analysis revealed that household economic status, incidence of hospitalisation, presence of an elderly or disabled household member in the family, and presence of a family member with a chronic illness were the common significant factors associated with household CHE. The crucial finding of the current study is that socioeconomic inequality plays an important role in the incidence of CHE all over the world, where low-income households are at high risk of financial hardship from healthcare payments. This suggests that healthcare financing policies should be revised in order to narrow the gap in socioeconomic inequality and social safety nets should be implemented and strengthened for people who have a high need for health care.

catastrophic illness; health expenditure; socioeconomic factors; worldwide; systematic review

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