Measuring the catastrophic and impoverishing effect of household health care spending in Serbia

► Different approaches applied in this paper indicate the robustness of the results, which is essential for future studies. ► Irrespectively of approaches applied, our results suggest that out-of-pocket patient payments push households into poverty. ► We identified as most vulnerable the chronically sick people, people living in larger households and/or in rural areas. ► Countries with ongoing health care reforms should pay attention to possible catastrophic effects of out-of-pocket payments.