This analysis investigates regional variation in catastrophic health care spending in Pakistan. METHODS:

The study draws data from three rounds of Pakistan Living Standards Measurement Survey (PLSM) conducted in both rural and urban areas of Pakistan in 2005-06, 2007-08 and 2010-11. A household is classified as incurring catastrophic health expenditure if 10% or more of its annual expenditure is on health care. Household economic status is measured using household annual consumption expenditures and households are categorized into quintiles.  RESULTS:

The proportion of households incurring catstrophic health care expenditure has declined from 7.5% in 2005-06 to 3.2% in 2010-11. The decline has been slightly more in case of rural households than in urban (4.9% urban and 9.1% rural households in 2005-06 vs. 2.0% urban and 3.8% rural households in 2010-11 incurred catastrophic health care spending. Of poorest households, 7.5% incurred catastrophic health expenditure in 2005-06, 5.4% in 2007-08 and 3.5% in 2010-11 whereas, of richest, the proportion was 6.2%, 5.4% and 2.7% for respective periods. Further, significantly more households in Punjab are incurring catastrophic health care expenditure compared to Sindh.

There is regional variation across regions and remarkable decline in catastrophic health care spending. South Punjab had the highest proportion (13.6%) while south Sindh had lowest proportion (2.4%) of households incurring health care expenditure in 2005-06. South Sindh still has the lowest proportion (0.4%) whereas, north Punjab replaces south Punjab having the highest proportion (5.4%) of households incurring catastrophic health expenditure in 2010-11. CONCLUSIONS:

Pakistan has registered a decline in catastrophic health care spending over the period. It could be associated with a decline in morbidity over the period. However, cost of health care remains an important impediment to access health care particularly in rural areas.