Measuring financial protection in health

Adam Wagstaff
The World Bank - Development Research Group - Human Development and Public Services Team
March 2008 - Policy Research Working Paper 4554

“…..Health systems are not just about improving health. Good ones also ensure that people are protected from the financial consequences of illness and death, or at least from the financial consequences associated with the use of medical care. Anecdotal evidence suggests health systems often perform badly in this respect, apparently with devastating consequences for households, especially poor ones and near-poor ones. The World Bank’s 50-country participatory poverty study known as Voices of the Poor1 found that poor health and illness are universally dreaded as a source of destitution, partly because of the costs of health care but also the income lost due to illness.

Voices of the Poor documents the case of a 26 year-old Vietnamese man who, as a result of the large health care costs necessitated by his daughter’s severe illness, has moved from being the richest man in his community to being one of the poorest.2 Also recorded was the case of a 30-year-old Indian mother of four who has been forced to sell the family’s home and land, and has to walk 10 kilometers a day transporting wood on her head in order to finance the cost of her diabetic husband’s medical care.

How can one measure the success with which a health system protects people against the financial consequences of ill health? What do systems that do well in this regard have in common? And how far do health system reforms improve people’s financial protection vis-à-vis health expenses?

This paper provides an overview of the methods and issues arising in each case, and presents empirical work in the area of financial protection in health, including the impacts of government policy. The paper also eviews a recent critique of the methods used to measure financial protection…….”