Determinants of catastrophic healthcare spending in Portugal (2005–2022)

The study analyses the extent, evolution and impoverishing effects of catastrophic health expenditures (CHE) in Portugal from 2005 to 2022. The analysis also identifies factors associated with the occurrence of CHE. The results show a progressive reduction in financial burden with increased access to healthcare services. CHE incidence decreased from 9.42% (2005) to 5.04% (2022). Reduced access to the Portuguese NHS was associated to increased reliance on private services and out-of-pocket costs. Barriers, unmet needs and challenges regarding the protection of vulnerable groups remain, including the elderly and individuals incapacitated to work. Households with at least one senior show a particular vulnerability to CHE. Regional disparities are reinforced by underdeveloped healthcare infrastructure, limited access and financial barriers.