CATA Meets IMPOV : A Unified Approach to Measuring Financial Protection in Health
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World Bank, Washington, DC
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Up to now catastrophic and impoverishing
payments have been seen as two alternative approaches to
measuring financial protection in health. Building on the
previous literature, the authors propose a unified
methodology in which impoverishing and catastrophic payments
are mutually exclusive outcomes. They achieve this by
expressing out-of-pocket payments as a ratio of
'discretionary' consumption, defined as the amount
by which total consumption (gross of out-of-pocket payments)
exceeds the poverty line. This allows the authors to
identify both households who are impoverished by
out-of-pocket payments (their ratio exceeds one) and
households who are pushed even further into poverty by
out-of-pocket payments (their ratio is negative); the
authors call such payments 'immiserizing'.
Households experiencing 'catastrophic' payments
are a subset of those who incur out-of-pocket payments but
who are neither impoverished nor immiserized by them. Two
alternative definitions of catastrophic payments are
offered: those that absorb more than a pre-specified
fraction of discretionary consumption; and those that leave
a household's nonmedical consumption (total consumption
net of out-of-pocket spending) below a pre-specified
multiple of the poverty line. The authors also offer a
simple financial protection index that reflects the
percentages of households incurring immiserizing,
impoverishing, catastrophic, non-catastrophic, and zero
out-of-pocket payments. They illustrate their unified
approach with data from the World Health Survey, using
international poverty lines and a catastrophic payment
threshold of 40 percent.
Palabras clave
ABILITY TO PAY, AGRICULTURAL GROWTH, CALORIE INTAKE, CALORIES PER PERSON, CONSUMER PRICE INDEX, CONSUMPTION AGGREGATE, CONSUMPTION DATA, CONSUMPTION POVERTY, DEVELOPMENT POLICY, EXTREME POVERTY, FAMILIES, FAMILY INCOME, FOOD EXPENDITURE, FOOD INTAKE, FOOD POLICY, FOOD SHARE, HEALTH CARE, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH INSURANCE, HEALTH SERVICES, HEALTH SYSTEM, HOUSEHOLD CONSUMPTION, HOUSEHOLD EXPENDITURE, HOUSEHOLD MEMBERS, HOUSEHOLD SPENDING, HOUSEHOLD SURVEY, HOUSEHOLD WELFARE, HOUSING, HUMAN DEVELOPMENT, INCOME DISTRIBUTION, INPATIENT CARE, INSURANCE, LIVING STANDARDS, MEDICAL SERVICES, NUTRITION, OUTPATIENT CARE, PATIENTS, POOR COUNTRIES, POOR HOUSEHOLDS, POVERTY ESTIMATES, POVERTY GAP, POVERTY LINE, POVERTY LINES, PURCHASING POWER, PURCHASING POWER PARITIES, SUBSISTENCE, TOTAL CONSUMPTION, USE VALUE, VALUE JUDGMENTS