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Improving the Measurement of Financial Protection in Health Systems
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Improving the Measurement of Financial Protection in Health Systems Dr Rodrigo Moreno-Serra Centre for Health Policy, Imperial College London [email protected] PCPH, Imperial College London, 5 th October 2011
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Improving the Measurement of Financial Protection in Health Systems. Dr Rodrigo Moreno-Serra Centre for Health Policy, Imperial College London [email protected] PCPH, Imperial College London, 5 th October 2011. Background. - PowerPoint PPT Presentation
Transcript of Improving the Measurement of Financial Protection in Health Systems
Improving the Measurement of Financial Protection in
Health Systems
Dr Rodrigo Moreno-SerraCentre for Health Policy, Imperial College London
PCPH, Imperial College London, 5th October 2011
Background
• Financial protection (FP): extent to which people are protected from the financial consequences of illness– Key objective of health care (HC) systems,
multidimensional– Financial hardship and lack of access to HC due to
costs still widespread (WHR 2010)– FP may suffer in a context of economic downturn– Monitoring FP is crucial for sound health policy
FP measurement: where are we?
• Focus on households’ living standards before and after direct payments for health (OOPs)
• OOPs reported in household surveysCatastrophic spending– OOPs cross set threshold in terms of share of
disposable income
Impoverishing spending– OOPs push household income below a chosen
poverty line
FP metrics: criticisms
1. Measurement of capacity to pay, effects of lost income etc...
2. Effect of financial barriers to access: the elephant in the room– Ability to pay may deter access to necessary HC– Linked to equity but indicator of FP extent – Sole focus on incurred spending may provide
misleading picture of FP
Catastrophic spending incidence and DTP3 immunization coverage among 1 year-olds, 87 countries (various years)
0 1 2 3 4 5 6 7 8 9 10 11 1240
50
60
70
80
90
100
UK
S. Africa
Canada
Djibouti
US
Tanzania
India
Lao PDRYemen
Greece
Georgia
Uganda
Portugal
Nepal
Indonesia
Bolivia
Ukraine
Kenya
China
Tajikistan
Cambodia
Russia
Colombia
Azerbaijan
Côte d'Ivoire
Malawi
Nicaragua
Brazil
Vietnam
Catastrophic health spending incidence (%)
DTP3
cov
erag
e am
ong
1-ye
ar o
lds (
%)
Source: Immunization data from WHO. Catastrophic spending incidence data from Xu et al. (2007). Financial catastrophe is defined as OOPs for health reaching at least 40% of a household’s non-subsistence income.
Financial barriers to access in high-income countries with low incidence of financial catastrophe
Australia
Canada
France
Germany
Netherlands
New Zealand
Norway
Sweden
Switz
erland UK
USA0
5
10
15
20
25
30
35
Had
pro
blem
s w
ith
acce
ss b
ecau
se o
f cos
t (%
)
Source: IHPS, Commonwealth Fund (Schoen et al. 2010).
Financial Protection Measures: Suggested Areas for Development
I. Complementing conventional FP indicators
• Coverage indicators– WHR 2010– Generally feasible route– But often limited information available– Role of various other determinants of coverage levels
• Access surveys– E.g., IHPS (Commonwealth Fund), World Health
Surveys (WHO), LSMS (World Bank)– Need implementation on routine and comparable
basis
II. Improving conventional FP indicators
• ‘Need-adjusted’ FP metrics– Estimate expected utilization and OOPs according
to ‘medical need’ characteristics– Adjust catastrophic and impoverishing spending
incidence (expected incidence)– May yield very different policy conclusions from
conventional analysis (e.g., Pradhan and Prescott 2002)
– But methodologically challenging
III. An exploratory tool: Data Envelopment Analysis (DEA)• Based on economic concept of production frontier
• Through linear programming, find units that achieve same (or better) outputs at lower use of inputs
• Efficiency = actual/optimal performance (OQA/OQ1)
• Can examine efficiency based on multiple outputs (e.g., FP indicators) and inputs
DEA applied to FP assessment
Financial protection proxy Mean Std. Dev. CountriesProtection against catastrophic spending (%) 96.9 2.7 58
Median immun. coverage (6 vaccines) (%) 84.4 11.8 58
Births attended by skilled personnel (%) 73.6 27.4 58
THE per capita (PPP, constant 2005 US$) 253.49 244.93 58
• Question: How do developing countries compare concerning efficiency in ‘producing’ FP given available resources (constraints)?
• Criteria for efficiency analysis: FP indicators relative to total health spending (THE) per capita (input orientation)
• Gets at the issue of achievable FP performance
DEA applied to FP assessment
DEA applied to FP assessment
Concluding remarks
• Financial barriers: distorting effects on conventional FP assessments
• Despite recent progress, we need better FP metrics for:– Policy guidance– International performance comparisons
• Huge potential gains from a health policy perspective
