Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.
Health Econ. 2021 Jan;30(1):186-193. doi: 10.1002/hec.4172. Epub 2020 Oct 2.
Financial protection in health is an essential aspect of the universal health coverage discourse. It is about ensuring that paying for health services does not affect the ability of households and individuals to afford necessities. A well-known way to assess financial protection is whether or not people are pushed into-or further into-poverty by paying out-of-pocket for health services. Although impoverishment from out-of-pocket health spending is not an explicit indicator of the sustainable development goals, it has gained prominence among researchers and policymakers because of its intuitive appeal and link to overall poverty reduction. Using data from Nigeria, this paper demonstrates that the choice of poverty line matters for assessing the impoverishing effect of paying out-of-pocket for health services. Among other things, the inconsistencies (or lack of dominance) could occur in ranking impoverishment levels by mutually exclusive groups within a country or in ranking different countries or a country over time. The implication is that the choice of poverty line could lead to manipulation of results for policy and for supporting an agenda that demonstrates an improvement in financial protection when this may not necessarily be the case.
健康方面的财务保护是全民健康覆盖话语的一个重要方面。它是指确保支付医疗服务费用不会影响家庭和个人负担基本生活必需品的能力。评估财务保护的一个著名方法是，人们是否因为支付医疗服务的自付费用而陷入或进一步陷入贫困。虽然因自付医疗支出而导致的贫困并不是可持续发展目标的明确指标，但由于其直观的吸引力和与整体减贫的联系，它在研究人员和政策制定者中引起了关注。本文利用来自尼日利亚的数据表明，选择贫困线对于评估因支付医疗服务的自付费用而导致的贫困化影响很重要。除其他外，在一个国家内相互排斥的群体之间或在不同国家或一个国家随时间的排名中，贫困程度的不一致性（或缺乏主导地位）可能会出现。这意味着贫困线的选择可能导致为政策和支持议程进行结果操纵，以表明在财务保护方面的改善，而实际上情况可能并非如此。
