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This paper provides an overview of research on out-of-pocket health expenditures, reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of gross domestic product spent on health. The two measures of dispersion or risk-the coefficient of variation and Q90/Q50-are only weakly correlated across countries and not explained by the macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of "catastrophic" expenditures. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of USD 1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.

Financial Protection --- Health Care Services Industry --- Health Costs --- Health Economics and Finance --- Health Finance --- Health Insurance --- Health, Nutrition and Population --- Inequality --- Labor and Employment Law --- Poverty Reduction --- Sdgs --- Sustainable Development Goals

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This paper outlines changes that have been made in the 2019 version of the Health Equity and Financial Protection Indicators database. On the financial protection side, the changes include an increase in the number of indicators from five to 14; revisions to several previous data points, reflecting the analysis of new surveys (or adaptations thereof); and refinements to the estimation of out-of-pocket expenditures. On the health equity side, the 2019 database includes 198 more data points than the 9,733 in the 2018 database, reflecting the addition of 535 new datapoints, and the dropping of 337 previously included data points now considered to be substandard.

Cancer --- Financial Protection --- Health --- Health Care Services Industry --- Health Economics and Finance --- Health Equity --- Health Indicators --- Health, Nutrition and Population --- Industry --- Inequality --- MDGs --- Millennium Development Goals --- Out-of-Pocket Health Expenditures --- Poverty --- Poverty Reduction --- SDGs --- Sustainable Development Goals --- Universal Health Coverage