Out-of-pocket expenditure and financial protection in the Chilean health care system—A systematic review 2017

Background: Protection against financial risk due to medical spending is an explicit healthguarantee within Chile’s AUGE health reform. This paper seeks to analyze the degree towhich out-of-pocket expenditure still expose  Chilean households to financial catastropheand impoverishment, and to explore inequalities in financial  protection.Methods: A systematic literature review was conducted to identify empirical studies ana-lyzing  financial protection in Chile. The search included databases as well as grey literature,i.e. governmental and institutional webpages. The indicators are based on the conceptualframework of financial protection, as  portrayed in the World Health Report 2013.Results: We identify n = 16 studies that fulfill the inclusion criteria.  Empirical studies indicatethat 4% of Chilean households faced catastrophic health expenditure defined as out- of-pocket expenditure exceeding 30% of household’s capacity to pay, while less than 1% werepushed into  poverty in 2012. In contrast to prior studies, recent data report that even pub-licly insured who should be fully  protected from co-payments were affected by catastrophichealth expenditure. Also in the private insurance system financial catastrophe is a commonrisk