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Financial protection in health revisited: Is catastrophic health spending underestimated for service‐ or disease‐specific analysis?

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  • John E. Ataguba
  • Hyacinth E. Ichoku
  • Marie‐Gloriose Ingabire
  • James Akazili

Abstract

Economists originally developed methods to assess financial catastrophe using total or aggregate out‐of‐pocket health spending. Aggregate out‐of‐pocket health spending is financially catastrophic when it exceeds a fixed proportion (i.e., threshold) of a household's total income or expenditure in a given period. However, these methods are now applied to assess financial catastrophe in disease‐ or service‐specific rather than aggregate out‐of‐pocket health spending without using disease‐ or service‐specific thresholds. This paper argues that not using disease‐ or service‐specific thresholds for such assessments is misleading and underestimates the burden of financial catastrophe, especially among households from poorer backgrounds. It then proposed disease‐ or service‐specific catastrophic payment thresholds, applied them to Nigeria and found that financial catastrophe was underestimated for the five service groups considered. The paper stresses the importance of using disease‐ or service‐specific thresholds and avoiding unadjusted thresholds, which may leave poorer households behind as financially protected.

Suggested Citation

  • John E. Ataguba & Hyacinth E. Ichoku & Marie‐Gloriose Ingabire & James Akazili, 2024. "Financial protection in health revisited: Is catastrophic health spending underestimated for service‐ or disease‐specific analysis?," Health Economics, John Wiley & Sons, Ltd., vol. 33(6), pages 1229-1240, June.
    • Handle: RePEc:wly:hlthec:v:33:y:2024:i:6:p:1229-1240
    DOI: 10.1002/hec.4813
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    References listed on IDEAS

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    1. 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.
    2. 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.
    3. John E. Ataguba, 2016. "Assessing equitable health financing for universal health coverage: a case study of South Africa," Applied Economics, Taylor & Francis Journals, vol. 48(35), pages 3293-3306, July.
    4. John E. Ataguba, 2022. "A short note revisiting the concentration index: Does the normalization of the concentration index matter?," Health Economics, John Wiley & Sons, Ltd., vol. 31(7), pages 1506-1512, July.
    5. 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.
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    Cited by:

    1. Tomson Ogwang & Germano Mwabu, 2024. "Adaptation of the Foster‐Greer‐Thorbecke poverty measures for the measurement of catastrophic health expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2419-2436, October.
    2. Tomson Ogwang & Germano Mwabu, 2025. "A Simple Measure of Catastrophic Health Expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 34(10), pages 1821-1831, October.

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