PHM-Exch> An Alternative Framework for Analyzing Financial Protection in Health

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC)
crossposted from: EQUIDAD at listserv.paho.org


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*An Alternative Framework for Analyzing Financial Protection in Health*

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**Jennifer Prah Ruger argues for a more multidemensional assessment of
financial protection in health,
which can better capture health expenditures and the full burden of health
cost burdens

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Yale Schools of Medicine and Public Health, New Haven, Connecticut, United
States of America****

*PLoS Med 9(8): e1001294. doi:10.1371/journal.pmed.1001294

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Published: August 21, 2012 at: http://bit.ly/NkzdFC

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Summary Points

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Inadequate financial protection in health increases people's vulnerability
and diminishes well-being, exacerbating inequities and raising moral
concerns. ****

Conventional indicators of financial protection such as catastrophic
spending and impoverishing spending are too narrowly conceived and likely
to underestimate the adverse effects of insufficient financial protection.

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Limitations of conventional indicators include failure to capture cost
barriers to access, differences in health care utilization by ability to
pay, different degrees of financial protection and coverage, “informal”
treatment payments, debt financing of health spending, reduced consumption
of other household necessities, as well as indirect costs of illness and
coping strategies.

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A multidimensional financial protection profile can capture interrelated
aspects of health expenditure, such as direct and indirect costs of
illness, coping strategies used to meet costs, insurance status and
utilization, household consumption patterns, and how health costs affect
them. ****

With the data the profile yields, researchers can further study health
costs' effects by poverty or income level and type of health treatment for
a fuller, more comprehensive view of health cost burdens and their
distribution. …”

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“…….Consensus had developed among academic and policy analysts on two
primary metrics, catastrophic and impoverishing spending, for financial
protection. Both methods use as a measure the percentage of out-of-pocket
health spending in households' overall spending. They differ in the way
medical spending is deemed problematic: catastrophic spending is above a
threshold percentage, while impoverishing spending pushes a household below
the poverty line. Both metrics are helpful indicators of the absolute and
relative level of household out-of-pocket health care spending and have
been employed in multiple studies worldwide.
Our research group conducted a study focusing on a modification of these
metrics—the out-of-pocket spending burden ratio using household equivalent
income derived from the Organisation for Economic Co-operation and
Development (OECD) Equivalence Scale [11].****

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But the consensus has given way, and critiques of the conventional approach
now run wide and deep. Critics include those who are most invested and who
have employed these methodologies,and those who argue that estimates of
household health expenditures themselves are subject to considerable
variability depending on survey design. ****

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This article proposes a multidimensional financial protection profile that
offers a more holistic view of health spending, one that goes beyond the
level of spending to cover aspects directly related to health care, such as
health care access and insurance utilization, and examines broader impacts
on current and longer-term household consumption. This multidimensional
approach aims to help policy makers understand the larger context of
household health spending and make health and social policy adjustments to
mitigate damaging effects…..”

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