{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:24:44Z","timestamp":1792063484745,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2003,4,22]],"date-time":"2003-04-22T00:00:00Z","timestamp":1050969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Economics"],"published-print":{"date-parts":[[2003,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This paper presents and compares two threshold approaches to measuring the fairness of health care payments, one requiring that payments do not exceed a pre\u2010specified proportion of pre\u2010payment income, the other that they do not drive households into poverty. We develop indices for \u2018catastrophe\u2019 that capture the intensity of catastrophe as well as its incidence and also allow the analyst to capture the degree to which catastrophic payments occur disproportionately among poor households. Measures of poverty impact capturing both intensity and incidence are also developed. The arguments and methods are empirically illustrated with data on out\u2010of\u2010pocket payments from Vietnam in 1993 and 1998. This is not an uninteresting application given that 80% of health spending in that country was paid out\u2010of\u2010pocket in 1998. We find that the incidence and intensity of \u2018catastrophic\u2019 payments \u2013 both in terms of pre\u2010payment income as well as ability to pay \u2013 were reduced between 1993 and 1998, and that both incidence and intensity of \u2018catastrophe\u2019 became less concentrated among the poor. We also find that the incidence and intensity of the poverty impact of out\u2010of\u2010pocket payments diminished over the period in question. Finally, we find that the poverty impact of out\u2010of\u2010pocket payments is primarily due to poor people becoming even poorer rather than the non\u2010poor being made poor, and that it was not expenses associated with inpatient care that increased poverty but rather non\u2010hospital expenditures. Copyright \u00a9 2003 John Wiley &amp; Sons, Ltd.<\/jats:p>","DOI":"10.1002\/hec.776","type":"journal-article","created":{"date-parts":[[2003,10,31]],"date-time":"2003-10-31T10:01:04Z","timestamp":1067594464000},"page":"921-933","source":"Crossref","is-referenced-by-count":894,"title":["Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993\u20131998"],"prefix":"10.1002","volume":"12","author":[{"given":"Adam","family":"Wagstaff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddy van","family":"Doorslaer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2003,4,22]]},"reference":[{"key":"e_1_2_1_2_2","volume-title":"Towards Decent Work: Social Protection in Health for all Workers and their Families. 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