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Reassessing catastrophic health-care payments with a Nigerian case study

Published online by Cambridge University Press:  11 February 2011

John Ele-Ojo Ataguba
John Ele-Ojo Ataguba*
Affiliation:
Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
*
Correspondence to: John E. Ataguba, Health Economics Unit, School of Public Health and Family Medicine, Falmouth Annex, Medical Campus, University of Cape Town, Observatory, 7925, Cape Town, South Africa. Email: John.Ataguba@uct.ac.za
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Abstract

Health financing reforms have recently received much attention in developing countries. However, out-of-pocket payments remain substantial. When such payments involve expenditures above some given proportion of household resources, they are often deemed ‘catastrophic’. The research literature on defining catastrophe leaves open a number of important questions and as a result there still exists a lack of consensus on the issue. This paper argues that there is a need to examine the question of what might constitute fair indices of catastrophic payment, which explicitly recognize diminishing marginal utility of income as reflected in some principle of vertical equity. It proposes the use of rank-dependent weights to allow variations in threshold payment levels across individuals on the income ladder. These are then applied to a Nigerian data set. It emerged that the catastrophic headcount (positive gap) obtained using a fixed threshold – weighted or not by the concentration index – is lower (higher) than that predicted by the rank-dependent threshold. More fundamentally there is a need for more research effort to take the ideas in this paper further and examine in various different contexts what a fair construct of catastrophe might look like.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 3 , 10 July 2012 , pp. 309 - 326
Copyright
Copyright © Cambridge University Press 2012

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References

Ataguba, J. E., Ichoku, H. E., Fonta, W. M. (2008), ‘Estimating the willingness to pay for community healthcare insurance in rural Nigeria’, Poverty and Economic Policy Research Network PMMA Working Paper 2008–10.CrossRefGoogle Scholar
Cissé, B., Luchini, S.Moatti, J. P. (2007), ‘Progressivity and horizontal equity in health care finance and delivery: what about Africa?’, Health policy, 80(1): 51–68.CrossRefGoogle ScholarPubMed
Culyer, A. J.Wagstaff, A. (1993), ‘Equity and equality in health and health care’, Journal of Health Economics, 12(1): 431–457.CrossRefGoogle ScholarPubMed
Daniels, N., Bryant, J., Castano, R. A., Dantes, O. G., Khan, K. S.Pannarunothai, S. (2000), ‘Benchmarks of fairness for health care reform: a policy tool for developing countries’, Bulletin of the World Health Organization, 78: 740–750.Google Scholar
Donaldson, D.Weymark, J. A. (1980), ‘A single-parameter generalization of the Gini indices of inequality’, Journal of Economic Theory, 22: 67–86.CrossRefGoogle Scholar
Donaldson, D.Weymark, J. A. (1983), ‘Ethically flexible Gini indices for income distributions in the continuum’, Journal of Economic Theory, 29(2): 353–358.CrossRefGoogle Scholar
Duclos, J. Y.Araar, A. (2006), Poverty and Equity: Measurement, Policy, and Estimation with Dad, Berlin and Ottawa: Springer and IDRC.CrossRefGoogle Scholar
Falkingham, J. (2004), ‘Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan’, Social Science & Medicine, 58(2): 247–258.CrossRefGoogle ScholarPubMed
Feenberg, D. R.Skinner, J. S. (1994), ‘The risk and duration of catastrophic health care expenditures’, The Review of Economics and Statistics, 76(4): 633–647.CrossRefGoogle Scholar
FOS (2004), National Living Standard Survey (NLSS) 2003/2004, Abuja, Nigeria: Federal Office of Statistics.Google Scholar
Gilson, L., Doherty, J., Lake, S., McIntyre, D., Mwikisa, C.Thomas, S. (2003), ‘The SAZA study: implementing health financing reform in South Africa and Zambia’, Health Policy and Planning, 18(1): 31–46.CrossRefGoogle ScholarPubMed
Ichoku, H. E., Fonta, W. M. (2006), ‘The distributional impact of healthcare financing in Nigeria: a case study of Enugu state’, Poverty and Economic Policy Research Network PMMA Working Paper No. 2006-17.Google Scholar
Kawabata, K., Xu, K.Carrin, G. (2002), ‘Preventing impoverishment through protection against catastrophic health expenditure’, Bulletin of the World Health Organization, 80(8): 612.Google ScholarPubMed
Kutzin, J. (2001), ‘A descriptive framework for country-level analysis of health care financing arrangements’, Health Policy, 56(3): 171–204.CrossRefGoogle ScholarPubMed
Leighton, C. (1995), ‘Overview: health financing reforms in Africa’, Health Policy and Planning, 10(3): 213–222.CrossRefGoogle ScholarPubMed
Leighton, C. (1996), ‘Strategies for achieving health financing reform in Africa’, World Development, 24(9): 1511–1525.CrossRefGoogle Scholar
Liu, X.Mills, A. (2002), ‘Financing reforms of public health services in China: lessons for other nations’, Social Science & Medicine, 54(11): 1691–1698.CrossRefGoogle Scholar
Lu, C., Chin, B., Lic, G.Murray, C. J. L. (2009), ‘Limitations of methods for measuring out-of-pocket and catastrophic private health expenditures’, Bulletin of the World Health Organization, 87: 238–244.CrossRefGoogle ScholarPubMed
Marmot, M. (2005), ‘Social determinants of health inequalities’, The Lancet, 365(9464): 1099–1104.CrossRefGoogle ScholarPubMed
McIntyre, D., Thiede, M., Dahlgren, G.Whitehead, M. (2006), ‘What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?’, Social Science & Medicine, 62(4): 858–865.CrossRefGoogle ScholarPubMed
Mooney, G. (1996), ‘And now for vertical equity? Some concerns arising from Aboriginal health in Australia’, Health Economics, 5(2): 99–103.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Mooney, G. (2009), Challenging Health Economics, New York: Oxford University Press.CrossRefGoogle Scholar
Mooney, G.Ataguba, J. E. (2009), ‘The global financial meltdown and the need for a political economy of health promotion’, Health Promotion Journal of Australia, 20(1): 3–4.CrossRefGoogle ScholarPubMed
Pediatrics (1987), ‘Health care financing for the child with catastrophic costs’, Journal of the American Society of Pediatrics, 80(5): 752–757.Google Scholar
Prescott, N., Pradhan, M. (1999), ‘Coping with Catastrophic Health Shocks’, Paper Read at Conference on Social Protection and Poverty.Google Scholar
Ranson, M. K. (2002), ‘Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges’, Bulletin of the World Health Organization, 80: 613–621.Google Scholar
Su, T. T., Kouyaté, B.Flessa, S. (2006), ‘Catastrophic household expenditure for health care in a low income society: a study from Nouna district, Burkina Faso’, Bulletin of the World Health Organization, 84(1): 21–27.CrossRefGoogle Scholar
van Doorslaer, E., O'Donnell, O., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Garg, C. C., Harbianto, D., Herrin, A. N., Huq, M. N.Ibragimova, S. (2007), ‘Catastrophic payments for health care in Asia’, Health Economics, 16(11): 1159–1184.CrossRefGoogle Scholar
Wagstaff, A. (2001), ‘Measuring equity in health care financing: reflections on (and alternatives to) world health organization's fairness of financing index’, World Bank Policy Research Working Paper 2550.Google Scholar
Wagstaff, A. (2002), ‘Poverty and health sector inequalities’, Bulletin of the World Health Organization, 80: 97–105.Google ScholarPubMed
Wagstaff, A.van Doorslaer, E. (2000), ‘Equity in health care finance and delivery’, Handbook of Health Economics, 1: 1803–1862.CrossRefGoogle Scholar
Wagstaff, A.van Doorslaer, E. (2003), ‘Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–98’, Health Economics, 12(11): 921–933.CrossRefGoogle Scholar
WHO (2000), The World Health Report 2000 – Health Systems: Improving Performance, Geneva: World Health Organisation.Google Scholar
WHO (2008), World Health Statistics 2008, Geneva: World Health Organisation.Google Scholar
Wyszewianski, L. (1986), ‘Financially catastrophic and high-cost cases: definitions, distinctions, and their implications for policy formulation’, Inquiry: A Journal of Medical Care Organization, Provision, 23(4): 382–394.Google ScholarPubMed
Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J.Murray, C. J. L. (2003), ‘Household catastrophic health expenditure: a multicountry analysis’, The Lancet, 362(9378): 111–117.CrossRefGoogle ScholarPubMed