From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <span dir="ltr"></span><div class="gmail_quote">crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br><br><br>




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<p class="MsoNormal" style="margin-left:.5in"><b><font color="maroon" face="Arial" size="3"><span style="font-size:12.0pt;font-family:Arial;color:maroon;font-weight:bold">An Alternative Framework for Analyzing Financial Protection
in Health<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in"><b><font color="maroon" face="Arial" size="3"><span style="font-size:12.0pt;font-family:Arial;color:maroon;font-weight:bold"><br>
</span></font></b><i><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-style:italic">Jennifer Prah Ruger argues for a more
multidemensional assessment of financial protection in health, <br>
which can better capture health expenditures and the full burden of health cost
burdens<br>
<br>
<u></u><u></u></span></font></i></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Yale Schools of Medicine and
Public Health, New Haven, Connecticut, United States of America<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold" lang="NO-BOK">PLoS
Med 9(8): e1001294. doi:10.1371/journal.pmed.1001294<br>
<br>
<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Published: August 21, 2012
at: </span></font><font face="Arial"><span style="font-size:10.0pt;font-family:Arial"><a href="http://bit.ly/NkzdFC" target="_blank"><font color="black"><span style="color:windowtext">http://bit.ly/NkzdFC</span></font></a><br>

<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Summary Points<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Inadequate financial
protection in health increases people's vulnerability and diminishes
well-being, exacerbating inequities and raising moral concerns. <u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">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. <br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">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. <br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">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. <u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">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. …”<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN"><u></u> <u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">“…….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.<br>
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].<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN"><u></u> <u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">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. <u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN"><u></u> <u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">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…..”<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN"><u></u> <u></u></span></font></p>

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