1. Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis
- Author
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Sebastián León-Giraldo, Catalina González-Uribe, Germán Casas, Oscar Bernal, Noemi Kreif, Juan Sebastián Cuervo-Sánchez, and Rodrigo Moreno-Serra
- Subjects
medicine.medical_specialty ,Physical disability ,Inequality ,media_common.quotation_subject ,Colombia ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Peace treaty ,Catastrophic Illness ,Socioeconomic status ,Health policy ,Health inequalities ,Social policy ,media_common ,business.industry ,030503 health policy & services ,Health Policy ,Public health ,Research ,1. No poverty ,Public Health, Environmental and Occupational Health ,Health services research ,Armed Conflicts ,16. Peace & justice ,3. Good health ,Geography ,Catastrophic expenditures ,Demographic economics ,Public aspects of medicine ,RA1-1270 ,Health Expenditures ,0305 other medical science ,business - Abstract
Background The present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016. Methods The study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method. Results The incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3 to 30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability. Conclusions Conflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.
- Published
- 2021