Out of pocket and catastrophic health spending in Mexico in the face of the COVID-19 pandemic

INTRODUCTION: The measurement of the financial coverage of a health system uses key indicators such as household out-of-pocket spending as well as catastrophic health spending. Said indicators depend on the financing structure of the health system as well as quality criteria and efficiency of the system in patient care. In the case of Mexico, in recent years there have been important changes in the structure of the health system in addition to suffering from the COVID-19 pandemic events that have significantly impacted the access to health of patients. Therefore, it is relevant to quantify the impact of these events on out-of-pocket spending and catastrophic spending on health in Mexico and have a robust diagnosis of the financial coverage of the system public health in Mexico. OBJECTIVES: The main objective of this study is to quantify out-of-pocket spending and catastrophic spending on health in Mexican households for the year 2020. Comparing these estimates with previous years given the recent changes in the Mexican health system as well as the effect of the COVID-19 pandemic in these indicators. METHODS: Based on the information available in the 2020 National Household Income and Expenditure Survey (ENIGH), out-of-pocket and catastrophic spending on health were estimated following the methodology proposed by the World Health Organization. A quantile regression was estimated to assess the effect of income distribution on out-of-pocket spending. RESULTS: In Mexico in 2020, 67.7% (24.2 million) of households had an out-of-pocket health expenditure (OOHE) and 6% of these households had a catastrophic health expenditure (CHE), with respect to all households this percentage represents 4.04%. According to the classification stipulated by the World Health Organization, healthcare has six expenditure components: orthopedics, medicines, maternity, hospital, alternative medicines, and ambulatory expenses. The three main expenditure was attributable to drugs (39.9%), ambulatory (25.3%), and hospital costs (20.3%). CONCLUSION: The effect of recent modifications to the public health system in Mexico in addition to the COVID-19 pandemic has been reflected in an increase in the percentage of households with out-of-pocket spending in Mexico, as well as the percentage of households with catastrophic spending in health. The main expense item is made in medicines, ambulatory care follow-up and hospitalization. It is a priority to establish efficient financial protection schemes that allow reversing this situation in terms of efficient access to health in Mexico.