Financial risk protection and universal health coverage: evidence and measurement challenges

Abstract

Financial risk protection is a key component of universal health coverage (UHC), which is defined as access to all needed quality health services without financial hardship. As part of the PLOS Medicine Collection on measurement of UHC, the aim of this paper is to examine and to compare and contrast existing measures of financial risk protection. The paper presents the rationale behind the methodologies for measuring financial risk protection and how this relates to UHC as well as some empirical examples of the types of measures. Additionally, the specific challenges related to monitoring inequalities in financial risk protection are discussed. The paper then goes on to examine and document the practical challenges associated with measurement of financial risk protection. This paper summarizes current thinking on the area of financial risk protection, provides novel insights, and suggests future developments that could be valuable in the context of monitoring progress towards UHC.

Figure 1. Impoverishment and catastrophic health expenditure headcount by country income.

Figure 2. Impoverishment headcount and difference in poverty gap by country income

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Figure 3. Box plot of OOP payments/expenditure net of basic food expenditure for 53 countries.

ARE, United Arab Emirates; BFA, Burkina Faso; BGD, Bangladesh; BIH, Bosnia and Herzegovina; BRA, Brazil; CHN, China; CIV, Côte d'Ivoire; COG, Congo; COM, Comoros; CZE, Czech Republic; DOM, Dominican Republic; ECU, Ecuador; ESP, Spain; EST, Estonia; ETH, Ethiopia; GEO, Georgia; GHA, Ghana; GTM, Guatemala; HRV, Croatia; HUN, Hungary; IND, India; KAZ, Kazakhstan; KEN, Kenya; LAO, Lao People's Democratic Republic; LKA, Sri Lanka; LVA, Latvia; MAR, Morocco; MEX, Mexico; MLI, Mali; MMR, Myanmar; MRT, Mauritania; MUS, Mauritius; MWI, Malawi; MYS, Malaysia; NAM, Namibia; NPL, Nepal; PAK, Pakistan; PHL, Philippines; PRY, Paraguay; RUS, Russian Federation; SEN, Senegal; SVK, Slovakia; SVN, Slovenia; SWZ, Swaziland; TCD, Chad; TUN, Tunisia; TUR, Turkey; UKR, Ukraine; URY, Uruguay; VNM, Viet Nam; ZAF, South Africa; ZMB, Zambia; ZWE, Zimbabwe.