Fairness
in the financial contributions of households to the health system is considered by WHO as
intrinsically valuable. WHO makes the normative claim that a health system is fairly
financed if the burden of total health payment for each household is the same. The equal
burden can be transformed as the ratio of total health system contribution of each
household through all payment mechanisms to that household's capacity to pay (effective
non-subsistence income) is identical for all households, independent of the household's
health status or use of the health system. Three distinct concerns, avoiding catastrophic
payments, equal payment by equivalent households and some element of progressivity, can be
captured by examining a household's health financing contribution.
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| To measure the
fairness of financial contribution of a health system, two key facts are needed: (a) how
much the household spends for health services and (b) how much is the household's
effective income above subsistence. WHO
is working with member states to identify income and expenditure surveys that can be used
to evaluate the distribution of household health system financial contributions and
important covariates of the household. Recent surveys are now available from 74 countries
and for some countries there are time series data, providing a total of 98 data points.
Most countries undertake periodic household income and expenditure surveys as a critical
input to the development of macro-economic indicators such as national accounts. This
means that in principle relevant micro-data exist for nearly every country. Currently, the
household survey data used include Living Standard Measurement Survey, Household Budgetary
Survey, Income and Consumption survey, socio-economic survey and other surveys including
income and expenditure information required for the analysis of fairness of financial
contribution, though lower cost surveys are being considered.
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