Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty
In the absence of formal health insurance, we argue that the strategies households adopt to finance health care have important implications for the measurement and interpretation of how health payments impact on consumption and poverty. Given data on source of finance, we propose to (a) approximate the relative impact of health payments on current consumption with a 'coping'-adjusted health expenditure ratio, (b) uncover poverty that is 'hidden' because total household expenditure is inflated by financial coping strategies and (c) identify poverty that is 'transient' because necessary consumption is temporarily sacrificed to pay for health care. Measures that ignore coping strategies not only overstate the risk to current consumption and exaggerate the scale of catastrophic payments but also overlook the long-run burden of health payments. Nationally representative data from India reveal that coping strategies finance as much as three-quarters of the cost of inpatient care. Payments for inpatient care exceed 10% of total household expenditure for around 30% of hospitalized households but less than 4% sacrifice more than 10% of current consumption to accommodate this spending. Ignoring health payments leads to underestimate poverty by 7-8% points among hospitalized households; 80% of this adjustment is hidden poverty due to coping. Copyright © 2008 John Wiley & Sons, Ltd.
Volume (Year): 17 (2008)
Issue (Month): 12 ()
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- Paul Gertler & Jonathan Gruber, 1998.
"Insuring Consumption Against Illness,"
JCPR Working Papers
41, Northwestern University/University of Chicago Joint Center for Poverty Research.
- Abhijit V. Banerjee & Esther Duflo, 2007.
"The Economic Lives of the Poor,"
Journal of Economic Perspectives,
American Economic Association, vol. 21(1), pages 141-168, Winter.
- Glenn R. Hubbard & Jonathan Skinner & Stephen P. Zeldes, .
"Precautionary Saving and Social Insurance,"
Rodney L. White Center for Financial Research Working Papers
03-95, Wharton School Rodney L. White Center for Financial Research.
- Glenn R. Hubbard & Jonathan Skinner & Stephen P. Zeldes, . "Precautionary Saving and Social Insurance," Rodney L. White Center for Financial Research Working Papers 3-95, Wharton School Rodney L. White Center for Financial Research.
- R. Glenn Hubbard & Jonathan Skinner & Stephen P. Zeldes, 1994. "Precautionary Saving and Social Insurance," NBER Working Papers 4884, National Bureau of Economic Research, Inc.
- Krishna, Anirudh, 2004. "Escaping Poverty and Becoming Poor: Who Gains, Who Loses, and Why?," World Development, Elsevier, vol. 32(1), pages 121-136, January.
- De Weerdt, Joachim & Dercon, Stefan, 2006.
"Risk-sharing networks and insurance against illness,"
Journal of Development Economics,
Elsevier, vol. 81(2), pages 337-356, December.
- Stefan Dercon & Joachim de Weerdt, 2004. "Risk-Sharing Networks And Insurance Against Illness," Development and Comp Systems 0409019, EconWPA.
- Stefan Dercon & Joachim De Weerdt, 2002. "Risk-sharing networks and insurance against illness," CSAE Working Paper Series 2002-16, Centre for the Study of African Economies, University of Oxford.
- Stefan Dercon & Joachim De Weerdt, 2002. "Risk-sharing Networks and Insurance against illness," Economics Series Working Papers WPS/2002-16, University of Oxford, Department of Economics.
- Lindelow, Magnus & Wagstaff, Adam, 2005. "Health shocks in China : are the poor and uninsured less protected ?," Policy Research Working Paper Series 3740, The World Bank.
- Foster, James & Greer, Joel & Thorbecke, Erik, 1984. "A Class of Decomposable Poverty Measures," Econometrica, Econometric Society, vol. 52(3), pages 761-66, May.
- Anirudh Krishna & Mahesh Kapila & Mahendra Porwal & Virpal Singh, 2005. "Why growth is not enough: Household poverty dynamics in Northeast Gujarat, India," Journal of Development Studies, Taylor & Francis Journals, vol. 41(7), pages 1163-1192.
- Elaina Rose, 1999. "Consumption Smoothing and Excess Female Mortality in Rural India," The Review of Economics and Statistics, MIT Press, vol. 81(1), pages 41-49, February.
- Jonathan Morduch, 1995.
"Income Smoothing and Consumption Smoothing,"
Harvard Institute of Economic Research Working Papers
1727, Harvard - Institute of Economic Research.
- Sauerborn, R. & Adams, A. & Hien, M., 1996. "Household strategies to cope with the economic costs of illness," Social Science & Medicine, Elsevier, vol. 43(3), pages 291-301, August.
- Robert M. Townsend, 1995. "Consumption Insurance: An Evaluation of Risk-Bearing Systems in Low-Income Economies," Journal of Economic Perspectives, American Economic Association, vol. 9(3), pages 83-102, Summer.
- Carter, Michael R. & Maluccio, John A., 2003. "Social Capital and Coping with Economic Shocks: An Analysis of Stunting of South African Children," World Development, Elsevier, vol. 31(7), pages 1147-1163, July.
- Beegle, Kathleen & Dehejia, Rajeev H. & Gatti, Roberta, 2006. "Child labor and agricultural shocks," Journal of Development Economics, Elsevier, vol. 81(1), pages 80-96, October.
- John Giles & Kyeongwon Yoo, 2007. "Precautionary Behavior, Migrant Networks, and Household Consumption Decisions: An Empirical Analysis Using Household Panel Data from Rural China," The Review of Economics and Statistics, MIT Press, vol. 89(3), pages 534-551, August.
- Sen, Binayak, 2003. "Drivers of Escape and Descent: Changing Household Fortunes in Rural Bangladesh," World Development, Elsevier, vol. 31(3), pages 513-534, March.
- Krishna, Anirudh, 2006. "Pathways out of and into poverty in 36 villages of Andhra Pradesh, India," World Development, Elsevier, vol. 34(2), pages 271-288, February.
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