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Measuring financial protection in health


  • Wagstaff, Adam


Health systems are not just about improving health: good ones also ensure that people are protected from the financial consequences of receiving medical care. Anecdotal evidence suggests health systems often perform badly in this respect, apparently with devastating consequences for households, especially poor ones and near-poor ones. Two principal methods have been used to measure financial protection in health. Both relate a household's out-of-pocket spending to a threshold defined in terms of living standards in the absence of the spending: the first defines spending as catastrophic if it exceeds a certain percentage of the living standards measure; the second defines spending as impoverishing if it makes the difference between a household being above and below the poverty line. The paper provides an overview of the methods and issues arising in each case, and presents empirical work in the area of financial protection in health, including the impacts of government policy. The paper also reviews a recent critique of the methods used to measure financial protection.

Suggested Citation

  • Wagstaff, Adam, 2008. "Measuring financial protection in health," Policy Research Working Paper Series 4554, The World Bank.
  • Handle: RePEc:wbk:wbrwps:4554

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    Cited by:

    1. Kim, Sujin & Kwon, Soonman, 2015. "Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea," Social Science & Medicine, Elsevier, vol. 138(C), pages 241-247.
    2. Grigorakis, Nikolaos & Floros, Christos & Tsangari, Haritini & Tsoukatos, Evangelos, 2016. "Out of pocket payments and social health insurance for private hospital care: Evidence from Greece," Health Policy, Elsevier, vol. 120(8), pages 948-959.
    3. repec:bla:glopol:v:8:y:2017:i::p:123-130 is not listed on IDEAS
    4. Victoria Fan & Anup Karan & Ajay Mahal, 2012. "State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India," International Journal of Health Economics and Management, Springer, vol. 12(3), pages 189-215, September.
    5. Binnendijk, Erika & Dror, David M. & Gerelle, Eric & Koren, Ruth, 2013. "Estimating Willingness-to-Pay for health insurance among rural poor in India by reference to Engel's law," Social Science & Medicine, Elsevier, vol. 76(C), pages 67-73.
    6. Rama Pal, 2010. "Analysing Catastrophic OOP Health Expenditure in India : Concepts, Determinants and Policy Implications," Microeconomics Working Papers 22775, East Asian Bureau of Economic Research.
    7. Bilger, Marcel, 2008. "Progressivity, horizontal inequality and reranking caused by health system financing: A decomposition analysis for Switzerland," Journal of Health Economics, Elsevier, vol. 27(6), pages 1582-1593, December.
    8. Jeannette Amaya Lara & Fernando Ruiz Gómez, 2011. "Determining factors of catastrophic health spending in Bogota, Colombia," International Journal of Health Economics and Management, Springer, vol. 11(2), pages 83-100, June.
    9. Aradhna Aggarwal, 2010. "Impact evaluation of India's ‘Yeshasvini’ community‐based health insurance programme," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 5-35, September.
    10. Arsenijevic, Jelena & Pavlova, Milena & Groot, Wim, 2013. "Measuring the catastrophic and impoverishing effect of household health care spending in Serbia," Social Science & Medicine, Elsevier, vol. 78(C), pages 17-25.

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    Health Monitoring&Evaluation; Health Systems Development&Reform; Health Economics&Finance; Rural Poverty Reduction;

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