Abstract
Universal health coverage (UHC) aims to provide access to health services for all without financial hardship. Moving toward UHC while ensuring financial risk protection (FRP) from out-of-pocket (OOP) health expenditures is a critical objective of the Sustainable Development Goal for Health. In tracking country progress toward UHC, analysts and policymakers usually report on two summary indicators of lack of FRP: the prevalence of catastrophic health expenditures (CHE) and the prevalence of impoverishing health expenditures. In this paper, we build on the CHE indicator: we examine the distribution (density) of health OOP budget share as a way to capture both the magnitude and dispersion in the ratio of households’ OOP health expenditures relative to consumption or income at the population level. We illustrate our approach with country-specific examples using data from the World Health Organization’s World Health Surveys.
Highlights
In 2015, the United Nations General Assembly set a list of 17 Sustainable Development Goals (SDGs) to be achieved by its member states by 2030
The coverage indicator aims to assess whether people in need of health services receive those services with sufficient quality; and a composite index was recently formulated to track this coverage indicator nationally [3,4,5]
We discuss the features of the distributional OOP share approach, of CFRP and IFRP, and their relevance to analyzing performance on financial risk protection (FRP), with the application to World Health Surveys (WHS) data to showcase the relevance of the approach
Summary
In 2015, the United Nations General Assembly set a list of 17 Sustainable Development Goals (SDGs) to be achieved by its member states by 2030. Governments and international agencies routinely report on two key indicators constructed by analysts to monitor progress toward UHC: a health services coverage indicator, and a financial risk protection (FRP) indicator. The FRP indicator aims to quantify the proportion of households that are protected from the financial risks associated with out-of-pocket (OOP) expenditures upon seeking health services. OOP health expenditures are considered “catastrophic” when they exceed a certain fraction (e.g. 10% ) of total household consumption expenditures or income [6, 7]. OOP health expenditures are considered “impoverishing” when they push total household consumption/income below a defined poverty line (e.g. international poverty line of $1.90 per day, Purchasing Power Parity)
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