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

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101147692 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-9276 (Electronic) Linking ISSN: 14759276 NLM ISO Abbreviation: Int J Equity Health Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] : BioMed Central, 2002-
    • Subject Terms:
      Armed Conflicts*/prevention & control ; Armed Conflicts*/statistics & numerical data ; Catastrophic Illness*/economics ; Health Expenditures*/statistics & numerical data; Colombia ; Humans
    • 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.
      (© 2021. The Author(s).)
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    • Grant Information:
      United Kingdom WT_ Wellcome Trust; MR/R013667/1 United Kingdom MRC_ Medical Research Council; MR/R013667/1 United Kingdom WT_ Wellcome Trust
    • Contributed Indexing:
      Keywords: Catastrophic expenditures; Colombia; Health inequalities; Peace treaty
    • Publication Date:
      Date Created: 20210930 Date Completed: 20211005 Latest Revision: 20231108
    • Publication Date:
      20240105
    • Accession Number:
      PMC8482681
    • Accession Number:
      10.1186/s12939-021-01555-7
    • Accession Number:
      34587942