NDLI: Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis

Content Provider	Springer Nature : BioMed Central
Author	León-Giraldo, Sebastián Cuervo-Sánchez, Juan Sebastián Casas, Germán González-Uribe, Catalina Kreif, Noemi Bernal, Oscar Moreno-Serra, Rodrigo
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.
Related Links	https://equityhealthj.biomedcentral.com/counter/pdf/10.1186/s12939-021-01555-7.pdf
Ending Page	14
Page Count	14
Starting Page	1
File Format	HTM / HTML
ISSN	14759276
DOI	10.1186/s12939-021-01555-7
Journal	International Journal for Equity in Health
Issue Number	1
Volume Number	20
Language	English
Publisher	BioMed Central
Publisher Date	2021-09-29
Access Restriction	Open
Subject Keyword	Public Health Health Promotion and Disease Prevention Health Services Research Health Policy Social Justice Equality and Human Rights Social Policy Colombia Peace treaty Catastrophic expenditures Health inequalities
Content Type	Text
Resource Type	Article
Subject	Health Policy Public Health, Environmental and Occupational Health
Journal Impact Factor	4.5/2023
5-Year Journal Impact Factor	4.7/2023

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