Catastrophic health expenditure

Population with household expenditures on health > 10% of total household expenditure or income (%)

Official estimate updated 8 January 2024

Population with household expenditures on health > 10% of total household expenditure or income (%)

Proportion of the population with household expenditure on health exceeding 10% of total household budget. (SDG 3.8.2)

Related publications

Global report Published 21 May 2024

World health statistics 2024: monitoring health for the SDGs, sustainable development goals

Statistical releases

Statistical release 19 May 2022

World Health Statistics 2022

Official WHO statistics for selected health-related SDG indicators and selected Thirteenth General Programme of Work indicators, based on data available in early 2022.

Statistical release 21 May 2024

World health statistics 2024: monitoring health for the SDGs, sustainable development goals

The World health statistics report is the annual compilation of health and health-related indicators, which has been published by the World Health Organization since 2005.

The 2024 edition reviews more than 50 health-related indicators from the Sustainable Development Goals and WHO’s Thirteenth General Programme of Work. It also highlights the findings from the Global health estimates 2021, notably the impact of the COVID-19 pandemic on life expectancy and healthy life expectancy.

Title and Description

Name	Population with household expenditures on health > 10% of total household expenditure or income (%)
Short name	Population with household expenditures on health > 10% of total household expenditure or income (%)
Indicator unique identifier	A65146D
Indicator codes	FINPROTECTION_CATA_TOT_10_POP
Also known as	SDG indicator 3.8.2 Financial hardship (SDG 3.8.2 10%)
SDG Goal	3.8.2 – Number of people covered by health insurance
Short description	Proportion of the population with household expenditure on health exceeding 10% of total household budget. (SDG 3.8.2)
Definition	Proportion of the population with household expenditure on health exceeding 10% of total household expenditure or income.
Direction of progress	Figures decreasing over time demonstrates progress.
Framework classifications	Impact ISO Health Indicators Conceptual Framework
Indicator status	Actively collected and reported

Publishing and updates

Most recent data update	8 January 2024
Next expected data update	2024/2025
Expected frequency of data release	Every 2 - 3 years
Publishing institution	WHO_HQ_UHL_HGF

Data copyright and licensing

Copyright	Attribution 4.0 International (CC BY 4.0)
License	The World Health Organization (“WHO”) encourages public access and use of the data that it collects and publishes on its web site data.who.int. The data are organized in datasets and made available in machine-readable format (“Datasets”). The Datasets have been compiled from data provided by WHO’s Member States under the WHO policy on the use and sharing of data collected by WHO in Member States outside the context of public health emergencies. Use of the data derived from the Datasets, which may appear in formats such as tables and charts, is also subject to these Terms and Conditions. Datasets may include data describing the Dataset called “Metadata”. If any datasets are credited to a source other than WHO, then those materials are not covered by these Terms and Conditions, and permission should be sought from the source provided. You are responsible for determining if this is the case, and if so, you are responsible for obtaining any necessary permission from the sources indicated. The risk of claims resulting from infringement of any third-party-owned component in the materials rests solely with you. You may use our application programming interfaces (“APIs”) to facilitate access to the Datasets, whether through a separate web site or through another type of software application. By using the Datasets or any presentations of data derived from them, or by using our APIs in connection with the Datasets, you agree to be bound by these Terms and Conditions, as may be amended from time to time by WHO at its sole discretion. Unless specifically indicated otherwise, these Datasets are provided to you under a Creative Commons Attribution 4.0 International License (CC BY 4.0), with the additional terms below.  The basic terms applicable to the CC BY 4.0 license may be accessed here. By downloading or using the Datasets, you agree to comply with the terms of the CC BY 4.0 license, as well as the following mandatory and binding addition: Any dispute relating to the interpretation or application of this license shall, unless amicably settled, be subject to conciliation. In the event of failure of the latter, the dispute shall be settled by arbitration. The arbitration shall be conducted in accordance with the modalities to be agreed upon by the parties or, in the absence of agreement, with the UNCITRAL Arbitration Rules. The parties shall accept the arbitral award as final.
Permission type	Publicly
Prohibited uses	You shall not attempt to de-anonymise the Datasets or use the Datasets in a manner that falsifies or misrepresents their content. You shall not, in connection with your use of the Datasets published on data.who.int, state or imply that WHO endorses, or is affiliated with, you, or that WHO endorses your use of data.who.int, or any content, output, or analysis resulting from or related to the data.who.int, or any entity, organization, company, product or services.
Citation	World Health Organization 2024 data.who.int, Population with household expenditures on health > 10% of total household expenditure or income (%) [Indicator]. https://data.who.int/indicators/i/B6D043E/A65146D (Accessed on 8 November 2024)
Disclaimers	WHO reserves the right at any time and from time to time to modify or discontinue, temporarily or permanently, the Datasets, or any means of accessing or utilizing the Datasets with or without prior notice to you. Maps The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas). The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the accuracy of the Datasets. However, the Datasets are being provided without warranty of any kind, either expressed or implied. You will be solely responsible for your use of the Datasets. In no event shall WHO be liable for any damages arising from such use. For full disclaimers, terms of use and your indemnification of WHO, please visit Terms and conditions.

About the data

Data type	Float
Unit of measure	Percentage of the population with household expenditures on health greater than 10% of total household budget
Value display label	% of population
Short value display label	%
Subject of measure	POPULATION
Subject of measure sentiment	Negative
Preferred semantic value type	Percentage of population
Confidence intervals	No
Provenance	Country, Territory or Area Reported
Calculation type	Predicted
First available data	31 December 1984
Most recent available data	31 December 2019
Data completeness	Incomplete data
Temporal coverage	1984 - 2019
Periodicity	Annual
Spatial coverage	World
Granularity	National
Population	Population facing catastrophic expenditures. Measured as the population weighted average of the number of households with “large household expenditures on health” as a share of total household expenditure or income (household’s budget). Large is defined as health expenditures exceeding 10% or 25% total household expenditure or income.
Number of countries, areas and territories	157
Geographic entities and groups	Afghanistan, Albania, Angola, Argentina, Armenia, Australia, Austria, Azerbaijan, Bahrain, Bangladesh, Barbados, Belarus, Belgium, Belize, Benin, Bhutan, Bolivia (Plurinational State of), Bosnia and Herzegovina, Botswana, Brazil, Bulgaria, Burkina Faso, Burundi, Cabo Verde, Cambodia, Cameroon, Canada, Central African Republic, Chad, Chile, China, Colombia, Comoros, Congo, Costa Rica, Côte d'Ivoire, Croatia, Cyprus, Czechia, Democratic Republic of the Congo, Denmark, Djibouti, Dominican Republic, Ecuador, Egypt, El Salvador, Estonia, Eswatini, Ethiopia, Fiji, Finland, Gabon, Gambia, Georgia, Germany, Ghana, Greece, Guatemala, Guinea, Guinea-Bissau, Haiti, Honduras, Hungary, Iceland, India, Indonesia, Iran (Islamic Republic of), Iraq, Ireland, Israel, Italy, Jamaica, Japan, Jordan, Kazakhstan, Kenya, Kiribati, Kyrgyzstan, Lao People's Democratic Republic, Latvia, Lebanon, Lesotho, Liberia, Lithuania, Luxembourg, Madagascar, Malawi, Malaysia, Maldives, Mali, Malta, Mauritania, Mauritius, Mexico, Mongolia, Montenegro, Morocco, Mozambique, Myanmar, Namibia, Nepal, Nicaragua, Niger, Nigeria, North Macedonia, Norway, Oman, Pakistan, Panama, Paraguay, Peru, Philippines, Poland, Portugal, Republic of Korea, Republic of Moldova, Romania, Russian Federation, Rwanda, Saint Lucia, Sao Tome and Principe, Saudi Arabia, Senegal, Serbia, Seychelles, Sierra Leone, Singapore, Slovakia, Slovenia, Somalia, South Africa, South Sudan, Spain, Sri Lanka, Sudan, Suriname, Sweden, Syrian Arab Republic, Tajikistan, Thailand, Timor-Leste, Togo, Trinidad and Tobago, Tunisia, Türkiye, Uganda, Ukraine, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, United Republic of Tanzania, United States of America, Uruguay, Uzbekistan, Viet Nam, Yemen, Zambia, Zimbabwe
Time intervals	1985, 1986, 1987, 1988, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019, 2020

Methodology

Numerator	Household expenditure on health is defined as any expenditure incurred at the time-of-service use to get any type of care (promotive, preventive, curative, rehabilitative, palliative or long-term care) including all medicines, vaccines and other pharmaceutical preparations as well as all health products, from any type of provider and for all members of the household. These health expenditures are characterized by direct payments that are financed by a household’s income (including remittances), savings or loans but do not include any third-party payer reimbursement. They are labelled Out-Of-Pocket (OOP) payments in the classification of health care financing schemes (HF) of the international Classification for Health Accounts (ICHA). They are the most unequitable source of funding for the health system as they are solely based on the willingness and ability to pay of the household; they only grant access to the health services and health products individuals can pay for, without any solidarity between the healthy and the sick beyond the household1, the rich and the poor; they represent a barrier to access for those people who are unable to find the economic resources need to pay out of their own pocket. The components of household expenditure on health should be consistent with division 06 on health of the UN Classification of Individual Consumption According to Purpose (COICOP) on medicines and medical products (06.1), outpatient care services (06.2) inpatient care services (06.3) and other health services (06.4).
Denominator	Expenditure on household consumption and household income are both monetary welfare measures. Household consumption is a function of permanent income, which is a measure of a household’s long-term economic resources that determine living standards. Consumption is generally defined as the sum of the monetary values of all items consumed by the household on domestic account during a reference period. It includes monetary expenditures on food and non-food non-durable goods and services consumed as well as the imputed values of goods and services that are not purchased but procured otherwise for consumption (value of in-kind consumption); the value use of durables, and the value use of owner-occupied housing. Information on household consumption is usually collected in household surveys that may use different approaches to measure ‘consumption’ depending on whether items refer to durable or non-durable goods and/or are directly produced by households. The most relevant measure of income is disposable income as it is close to the maximum available to the household for consumption expenditure during the accounting period. Disposable income is defined as total income less direct taxes (net of refunds), compulsory fees and fines. Total income is generally composed of income from employment, property income, income from household production of services for own consumption, transfers received in cash and goods, and transfers received as services. Income is more difficult to measure accurately due to its greater variability over time. Consumption is less variable over time and easier to measure. It is therefore recommended that whenever there is information on both household consumption and income the former is used (see the “comments and limitations” section to learn more about the sensitivity of 3.8.2 to the income/expenditure choice in the denominator). Statistics on 3.8.2 currently produced by WHO and the World Bank predominantly rely on consumption.
Method of estimation aggregates	The global and regional incidence of the proportion of the population with household expenditures on health greater than 10% of total household expenditure or income is estimated as the population weighted average of the country level share of people with such catastrophic health expenditures (SDG 3.8.2, 10% threshold) for a reference year. Incidence at the country level for the reference year is estimated using different methods depending upon the availability of information for that country around or at the reference year (T). • In countries for which there is an observed incidence rate of the SDG indicator 3.8.2 at the 10% threshold in the reference year T, this point is used. • When there are at least two observed incidence rates of the SDG indicator 3.8.2 at the 10% threshold around the reference over a 5 year window around the reference year [T–5; T+5], linear interpolation is used to project the value of the proportion of “the population with household expenditures on health greater than 10% of total household expenditure or income” in the reference year. • If only one observed incidence rate of the SDG indicator 3.8.2 at the 10% threshold is available either before or after the reference year and within a five year window before or after the reference year (T+ or T-5),, a multilevel model of the rate of catastrophic payments (SDG indicator 3.8.2, 10% threshold) is ¬estimated using the aggregate share of OOP over total consumption expenditure as the explanatory variable • For countries with no observed incidence rate over a 10-year window around the reference year, the multilevel model is used to project the survey point to the reference year using the share of aggregate OOP over total consumption if that information is available. If such information is not available, the regional median value of the SDG indicator 3.8.2 at the 10% threshold is used instead to impute the incidence rate for those countries in the reference year. The country estimates for the reference year are then aggregated up to the regional and global levels to compute the “Total population with household expenditures on health greater than 10% of total household income or expenditure” in millions. The proportion of the total population at global and regional level is then calculated by expressing these numbers as a share of the relevant population, equivalent to taking a population-weighted average of the relevant country rates.
Process of validation	The microdata obtained by WHO is requested to National Statistical Offices with the denominator (household total consumption expenditure) already constructed following their own guidelines and follows those guidelines when the denominator is not provided. The microdata obtained by the World Bank is provided by country governments and typically includes the denominator and the numerator already constructed. Sometimes, the World Bank has to construct the welfare aggregate or adjust the aggregate provided by the country. The microdata obtained by both institutions to track SDG indicator 3.8.2 has typically already been checked for quality to track other important indicators (e.g. SDG indicator 1.1.1). A quality assessment is performed before consulting countries on SDG 3.8.2 estimates (see section 4.k). The estimates produced by both organizations are included in a consultation to obtain country’s feedback and revised as needed.
Institutional mandate	WHO support for monitoring the financial protection dimension of Universal Health Coverage (target 3.8, indicator 3.8.2 specifically) is underpinned by Resolution WHA58.33 on sustainable health financing, universal coverage and social health insurance.
Associated resolutions	WHA58.33 EB107.R8

Data sources

Data collection process	WHO and the World Bank contact Ministries of Health and/or National statistical offices for two purposes: a) request access to the household survey microdata in order to produce SDG indicator 3.8.2; b) request estimates produced by the country itself. A) The first type of request is done by each organization separately. WHO obtains access to the household survey microdata from national statistical offices through its regional offices or country offices. Access request is often part of technical assistance programs on health financing issues. The World Bank also typically receives data from National Statistical Offices (NSOs) directly. In other cases, it uses NSO data received indirectly. For example, it receives data from Eurostat and from LIS (Luxembourg Income Study), who provide the World Bank NSO data in its original form or harmonized for comparability. The Universidad Nacional de La Plata, Argentina and the World Bank jointly maintain the SEDLAC (Socio-Economic Database for Latin American and Caribbean) database that includes harmonized statistics on poverty and other distributional and social variables from 24 Latin American and Caribbean countries, based on microdata from household surveys conducted by NSOs. Data is obtained through country specific programs, including technical assistance programs and joint analytical and capacity building activities. The World Bank has relationships with NSOs on work programs involving statistical systems and data analysis. Poverty economists from the World Bank typically engage with NSOs broadly on poverty measurement and analysis as part of technical assistance activities. The World Health Organization and the World Bank regularly undertake training events on the measurement of lack of financial protection coverage to produce SDG 3.8.2 indicator. This type of activity involves participants from the Ministry of Health as well as from the National Statistical Office. All the country-year estimates produced by both organizations are assembled in a joint database following a quality assessment process. Such estimates are included in a country consultation conducted to give an opportunity to i) review the estimates, the data sources and the methods used for computation; ii) provide information about additional data sources; iii) build mutual understanding of the strengths and weaknesses of available data and ensure broad ownership of the results; and iv) request estimates produced by the country as further explained hereafter. B) Estimates produced by each country are requested through a country consultation conducted by the World Health Organization. Following the WHO Executive Board resolution (EB107.R8), this process starts with WHO sending a formal request to ministries of health to nominate a focal point for the consultation. WHO sends draft estimates and methodological descriptions to them, copying countries’ focal point for SDG reporting where nominated at the request of UNSD. STATA codes are available to reproduce the estimates shared. The focal points then send to WHO their comments, often including new data or revised country estimates that are used to update the country estimates. Estimates produced by the countries are subject to the same quality assessment process and included in the joint database if they are not flagged in consumption or in the health budget share.
Preferred data sources	household surveys with information on both household consumption expenditure on health and total household consumption expenditures, which are routinely conducted by national statistical offices. Household budget surveys (HBS) and household income and expenditure surveys (HIES) typically collect these as they are primarily conducted to provide inputs to the calculation of consumer price indices or the compilation of national accounts. Another potential source of information is socio-economic or living standards surveys; however, some of these surveys may not collect information on total household consumption expenditures – for example, when a country measures poverty using income as the welfare indicator4. The most important criterion for selecting a data source to measure SDG indicator 3.8.2 is the availability of both household consumption expenditure on health and total household consumption expenditures.
Other data sources	Health surveys with a module on household expenditures
Expected frequency of data collection	Every 1–5 years depending on implementation of population-based household expenditure surveys led by national statistics offices
Data providers	National Statistical Offices in collaboration with Ministries of health.
Data compilers	World Health Organization (WHO), World Bank

Copyright and Licensing

Copyright	Attribution 4.0 International (CC BY 4.0)
License	The World Health Organization (“WHO”) encourages public access and use of the data that it collects and publishes on its web site data.who.int. The data are organized in datasets and made available in machine-readable format (“Datasets”). The Datasets have been compiled from data provided by WHO’s Member States under the WHO policy on the use and sharing of data collected by WHO in Member States outside the context of public health emergencies. Use of the data derived from the Datasets, which may appear in formats such as tables and charts, is also subject to these Terms and Conditions. Datasets may include data describing the Dataset called “Metadata”. If any datasets are credited to a source other than WHO, then those materials are not covered by these Terms and Conditions, and permission should be sought from the source provided. You are responsible for determining if this is the case, and if so, you are responsible for obtaining any necessary permission from the sources indicated. The risk of claims resulting from infringement of any third-party-owned component in the materials rests solely with you. You may use our application programming interfaces (“APIs”) to facilitate access to the Datasets, whether through a separate web site or through another type of software application. By using the Datasets or any presentations of data derived from them, or by using our APIs in connection with the Datasets, you agree to be bound by these Terms and Conditions, as may be amended from time to time by WHO at its sole discretion. Unless specifically indicated otherwise, these Datasets are provided to you under a Creative Commons Attribution 4.0 International License (CC BY 4.0), with the additional terms below.  The basic terms applicable to the CC BY 4.0 license may be accessed here. By downloading or using the Datasets, you agree to comply with the terms of the CC BY 4.0 license, as well as the following mandatory and binding addition: Any dispute relating to the interpretation or application of this license shall, unless amicably settled, be subject to conciliation. In the event of failure of the latter, the dispute shall be settled by arbitration. The arbitration shall be conducted in accordance with the modalities to be agreed upon by the parties or, in the absence of agreement, with the UNCITRAL Arbitration Rules. The parties shall accept the arbitral award as final.
Permission type	Publicly
Prohibited uses	You shall not attempt to de-anonymise the Datasets or use the Datasets in a manner that falsifies or misrepresents their content. You shall not, in connection with your use of the Datasets published on data.who.int, state or imply that WHO endorses, or is affiliated with, you, or that WHO endorses your use of data.who.int, or any content, output, or analysis resulting from or related to the data.who.int, or any entity, organization, company, product or services.
Citation	World Health Organization 2024 data.who.int, Population with household expenditures on health > 10% of total household expenditure or income (%) [Indicator]. https://data.who.int/indicators/i/B6D043E/A65146D (Accessed on 8 November 2024)
Disclaimer	WHO reserves the right at any time and from time to time to modify or discontinue, temporarily or permanently, the Datasets, or any means of accessing or utilizing the Datasets with or without prior notice to you. Maps The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999). A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas). The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the accuracy of the Datasets. However, the Datasets are being provided without warranty of any kind, either expressed or implied. You will be solely responsible for your use of the Datasets. In no event shall WHO be liable for any damages arising from such use. For full disclaimers, terms of use and your indemnification of WHO, please visit Terms and conditions.

Population with household expenditures on health > 10% of total household expenditure or income (%)