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Revista de Salud Pública

Print version ISSN 0124-0064


ALVIS-ZAKZUK, Jossie et al. Out-of-pocket and catastrophic health expenditure in households of Cartagena, Colombia. Rev. salud pública [online]. 2018, vol.20, n.5, pp.591-598. ISSN 0124-0064.


To estimate out-of-pocket (OOP) health expenditure and the probability to incur in catastrophic health expenditure, as well as the socio-demographic determinants of households in Cartagena, Colombia.

Materials and Methods

Population-based cross-sectional study on a randomized stratified sample of Cartagena households. Two regression models were developed using OOP health expenditure and the probability to incur in catastrophic health expenditure as dependent variables.


The average annual OOP health expenditure was $1 566 036 COP (US$783) (95%CI: $1 117 597 - $2 014 475) in poor households, $2 492 928 COP (US$1 246) (95%CI: $1 695 845 - $3 290 011) in middle class households, and $4 577 172 COP (uS$2 288) (95%CI: $1 838 222 - $7 316 122) in upper class households. Regarding the household income ratio, the OOP health expenditure was 14.6% in poor households, 8.2% in middle class, and 7.0% in upper class households. The probability to incur in catastrophic health expenditure was 30.6% (95%CI: 25.6% - 35.5%), 10.2% (95%CI: 4.5%-15.9%) and 8.6% (95%CI: 1.8%-23%) in the low, middle- and high-class households, respectively. Educational attainment, socioeconomic strata and employment were the main determinants of OOP and the probability to incur in catastrophic health expenditure.


The health system has persistent inequalities regarding the financial protection of households related to out-of-pocket expenditure and the probability of catastrophic expenditure. This study provides evidence to review the social protection policy for the most socio-economically vulnerable households.

Keywords : Health expenditures; health equity (source: MeSH, NLM).

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