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Assessing financial protection in health: Does the choice of poverty line matter?


  • John E. Ataguba


Financial protection in health is an essential aspect of the universal health coverage discourse. It is about ensuring that paying for health services does not affect the ability of households and individuals to afford necessities. A well‐known way to assess financial protection is whether or not people are pushed into—or further into—poverty by paying out‐of‐pocket for health services. Although impoverishment from out‐of‐pocket health spending is not an explicit indicator of the sustainable development goals, it has gained prominence among researchers and policymakers because of its intuitive appeal and link to overall poverty reduction. Using data from Nigeria, this paper demonstrates that the choice of poverty line matters for assessing the impoverishing effect of paying out‐of‐pocket for health services. Among other things, the inconsistencies (or lack of dominance) could occur in ranking impoverishment levels by mutually exclusive groups within a country or in ranking different countries or a country over time. The implication is that the choice of poverty line could lead to manipulation of results for policy and for supporting an agenda that demonstrates an improvement in financial protection when this may not necessarily be the case.

Suggested Citation

  • John E. Ataguba, 2021. "Assessing financial protection in health: Does the choice of poverty line matter?," Health Economics, John Wiley & Sons, Ltd., vol. 30(1), pages 186-193, January.
  • Handle: RePEc:wly:hlthec:v:30:y:2021:i:1:p:186-193
    DOI: 10.1002/hec.4172

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    References listed on IDEAS

    1. Jean‐Yves Duclos & Paul Makdissi, 2005. "Sequential Stochastic Dominance And The Robustness Of Poverty Orderings," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 51(1), pages 63-87, March.
    2. John E. Ataguba & Hyacinth E. Ichoku & Chijioke O. Nwosu & James Akazili, 2020. "An Alternative Approach to Decomposing the Redistributive Effect of Health Financing Between and Within Groups Using the Gini Index: The Case of Out-of-Pocket Payments in Nigeria," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 747-757, December.
    3. Russell Davidson & Jean-Yves Duclos, 2000. "Statistical Inference for Stochastic Dominance and for the Measurement of Poverty and Inequality," Econometrica, Econometric Society, vol. 68(6), pages 1435-1464, November.
    4. Ataguba, John Ele-Ojo, 2012. "Reassessing catastrophic health-care payments with a Nigerian case study," Health Economics, Policy and Law, Cambridge University Press, vol. 7(3), pages 309-326, July.
    5. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    6. Foster, James & Greer, Joel & Thorbecke, Erik, 1984. "A Class of Decomposable Poverty Measures," Econometrica, Econometric Society, vol. 52(3), pages 761-766, May.
    7. Ravallion, Martin & Chen, Shaohua, 2019. "Global poverty measurement when relative income matters," Journal of Public Economics, Elsevier, vol. 177(C), pages 1-1.
    8. Sahn, David E. & Stifel, David C., 2000. "Poverty Comparisons Over Time and Across Countries in Africa," World Development, Elsevier, vol. 28(12), pages 2123-2155, December.
    9. World Health Organization & World Bank, 2017. "Tracking Universal Health Coverage," World Bank Publications - Books, The World Bank Group, number 29042, December.
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    1. Chris Sampson’s journal round-up for 4th January 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-01-04 12:00:05


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