A Subnational Review of Temporal and Spatial Factors in Catastrophic Health Expenditure

Abstract

A substantial body of research has documented the adverse effects of catastrophic health expenditure (CHE) on household financial stability and access to healthcare. However, much of the literature examined CHE from a limited perspective, focusing either on temporal trends or on spatial differences at a single point in time. As a result, earlier findings were often inconsistent and provided only a partial understanding of the magnitude and distribution of CHE, particularly in low- and middle-income countries such as Pakistan. This study examined the impact of CHE on household financial stability and access to healthcare services while capturing variations across provinces and over time. By combining multiple analytical perspectives, the research provided a more nuanced and context-specific understanding of CHE than previous studies. This study employs secondary data from the Household Integrated Economic Survey (HIES) spanning 2007 to 2019, obtained from official government reports and regional healthcare sources. Six survey rounds, 2007–08, 2010–11, 2011–12, 2013–14, 2015–16, and 2018–19, are used to group household expenditure and annual income data from the HIES. Threshold levels of 10%, 25%, and 40% are applied across all six survey periods for both national and sub-national analysis. The use of diverse data sources enabled the study to capture household-level characteristics, regional healthcare utilization patterns, and broader economic and health system indicators over time. Demographic and socioeconomic variables, such as household income and household size, were incorporated to account for differences in household vulnerability. The study examines the likelihood of households incurring catastrophic health expenditure while controlling for demographic, economic, and spatial factors. This analytical strategy made it possible to identify key determinants of CHE and to assess how the risk of catastrophic spending varied across provinces and over time. The findings generated through this research contributed to a deeper understanding of the patterns and drivers of catastrophic health expenditure in Pakistan.