SciELO - Scientific Electronic Library Online

vol.8 issue2 author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




  • Have no cited articlesCited by SciELO

Related links

  • Have no similar articlesSimilars in SciELO


Revista de salud publica del Paraguay

Print version ISSN 2224-6193On-line version ISSN 2307-3349


EDGAR, Giménez Caballero; LAURA, Flores  and  NESTOR, Peralta. Policies and programs that reduce catastrophic health expenditures in low and middle income countries. Rev. salud publica Parag. [online]. 2018, vol.8, n.2, pp.57-65. ISSN 2307-3349.


Identify the policies and programs that have managed to reduce catastrophic health spending in low and middle-income countries.


A systematic review of publications between January 2013 and December 2017 through a strategy of sequential search with keywords and selection using PICO inclusion criteria. We included experimental, quasi-experimental and other controlled comparison designs.


We identified 5,668 publications that assess catastrophic expenditures, of which 4,678 were related to different frequent health interventions that act on the financing model, 860 used rigorous methodologies and 443 corresponded to low and middle-income countries. We reviewed titles and abstracts, and 44 publications were pre-selected and extensively revised. We included 8 publications for the analysis: 3 carried out in China, 2 in India, 1 in Lao, 1 in Indonesia and 1 in Mexico. In the impact evaluation, 4 did not show statistically significant variations. Another 4 showed a reduction in catastrophic spending, through different models of public management insurance.


It is possible to expand the financial protection of the population and avoid catastrophic expenses in the face of diseases, under certain conditions and through specific interventions such as public insurance schemes. The collection of rigorous evidence in scarce and more studies are needed on other models of interventions.

Keywords : Financial protection in health; health financing; out of pocket payments;catastrophic health expenditure; universal health coverage..

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )