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Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges

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  • Priyanka Saksena
  • Justine Hsu
  • David B Evans

Abstract

: As part of a PLOS Collection on universal health coverage, Priyanka Saksena and colleagues examine existing measures of financial risk protection and suggest future developments that could be valuable in monitoring progress towards universal health coverage. 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.

Suggested Citation

  • Priyanka Saksena & Justine Hsu & David B Evans, 2014. "Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-11, September.
    • Handle: RePEc:plo:pmed00:1001701
    DOI: 10.1371/journal.pmed.1001701
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    1. Vollmer, Frank & Zorrilla-Miras, Pedro & Baumert, Sophia & Luz, Ana Catarina & Woollen, Emily & Grundy, Isla & Artur, Luis & Ribeiro, Natasha & Mahamane, Mansour & Patenaude, Genevieve, 2017. "Charcoal income as a means to a valuable end: Scope and limitations of income from rural charcoal production to alleviate acute multidimensional poverty in Mabalane district, southern Mozambique," World Development Perspectives, Elsevier, vol. 7, pages 43-60.
    2. Lan My Le & Gabriela Flores & Tessa Tan-Torres Edejer & Toan Khanh Tran & Chuc Thi Kim Nguyen & Do Thanh Tran & Phuc Dang Ho & Isaiah Awintuen Agorinya & Fabrizio Tediosi & Amanda Ross, 2020. "Investigating the effect of recall period on estimates of inpatient out-of-pocket expenditure from household surveys in Vietnam," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-14, November.
    3. Philip Ayizem Dalinjong & Alex Y Wang & Caroline S E Homer, 2018. "Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-19, February.
    4. Koch, Kira Johanna & Cid Pedraza, Camilo & Schmid, Andreas, 2017. "Out-of-pocket expenditure and financial protection in the Chilean health care system—A systematic review," Health Policy, Elsevier, vol. 121(5), pages 481-494.
    5. Darker, Catherine D. & Donnelly-Swift, Erica & Whiston, Lucy, 2018. "Demographic factors and attitudes that influence the support of the general public for the introduction of universal healthcare in Ireland: A national survey," Health Policy, Elsevier, vol. 122(2), pages 147-156.
    6. Connolly, Sheelah & Wren, Maev-Ann, 2023. "Towards universal healthcare in Ireland – what can we learn from the literature?," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT121.
    7. Chen, Yi & Shi, Julie & Zhuang, Castiel Chen, 2019. "Income-dependent impacts of health insurance on medical expenditures: Theory and evidence from China," China Economic Review, Elsevier, vol. 53(C), pages 290-310.
    8. Yerramilli, Pooja & Fernández, Óscar & Thomson, Sarah, 2018. "Financial protection in Europe: a systematic review of the literature and mapping of data availability," Health Policy, Elsevier, vol. 122(5), pages 493-508.
    9. Sunday A. Adebisi & Joyce M.Odiachi & Ngozi A. Chikere, 2019. "The National Health Insurance Scheme (NHIS) in Nigeria: Has the Policy Achieved its Intended Objectives?," Academic Journal of Economic Studies, Faculty of Finance, Banking and Accountancy Bucharest,"Dimitrie Cantemir" Christian University Bucharest, vol. 5(3), pages 97-104, September.
    10. Pantig, Ida Marie T., 2015. "Sustainability of the National Government Premium Subsidy for Indigents," Philippine Journal of Development PJD 2013 Vol. 40 Nos. 1-2, Philippine Institute for Development Studies.
    11. Hajizadeh, Mohammad & Pandey, Sujita & Pulok, Mohammad Habibullah, 2023. "Decomposition of socioeconomic inequalities in catastrophic out-of-pocket expenditure for healthcare in Canada," Health Policy, Elsevier, vol. 127(C), pages 51-59.
    12. Xiaochen Ma & Ziyue Wang & Xiaoyun Liu, 2019. "Progress on Catastrophic Health Expenditure in China: Evidence from China Family Panel Studies (CFPS) 2010 to 2016," IJERPH, MDPI, vol. 16(23), pages 1-11, November.
    13. Purcel, Alexandra-Anca & Dragos, Cristian Mihai & Mare, Codruța & Dragos, Simona Laura, 2023. "Voluntary health insurance and out-of-pocket payments in European OECD countries," Economic Modelling, Elsevier, vol. 120(C).
    14. Johnston, Bridget M. & Burke, Sara & Barry, Sarah & Normand, Charles & Ní Fhallúin, Maebh & Thomas, Steve, 2019. "Private health expenditure in Ireland: Assessing the affordability of private financing of health care," Health Policy, Elsevier, vol. 123(10), pages 963-969.
    15. Anupa Rijal & Tara Ballav Adhikari & Jahangir A M Khan & Gabriele Berg-Beckhoff, 2018. "The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-23, November.
    16. Scheil-Adlung, Xenia., 2015. "Long-term care protection for older persons : a review of coverage deficits in 46 countries," ILO Working Papers 994886493402676, International Labour Organization.
    17. Barnes, Kayleigh & Mukherji, Arnab & Mullen, Patrick & Sood, Neeraj, 2017. "Financial risk protection from social health insurance," Journal of Health Economics, Elsevier, vol. 55(C), pages 14-29.
    18. Elham Ahmadnezhad & Adrianna Murphy & Rezvaneh Alvandi & Zhaleh Abdi, 2019. "The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1833-1845, October.
    19. Oliver Kaonga & Charles Banda & Felix Masiye, 2019. "Hardship financing of out-of-pocket payments in the context of free healthcare in Zambia," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-14, April.
    20. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    21. Grigorakis, Nikolaos & Floros, Christos & Tsangari, Haritini & Tsoukatos, Evangelos, 2018. "Macroeconomic and financing determinants of out of pocket payments in health care: Evidence from selected OECD countries," Journal of Policy Modeling, Elsevier, vol. 40(6), pages 1290-1312.
    22. Robert J. Kolesar & Sambo Pheakdey & Bart Jacobs & Narith Chan & Samedy Yok & Martine Audibert, 2020. "Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations," International Social Security Review, John Wiley & Sons, vol. 73(1), pages 35-63, January.
    23. Chantzaras, Athanasios E. & Yfantopoulos, John N., 2018. "Financial protection of households against health shocks in Greece during the economic crisis," Social Science & Medicine, Elsevier, vol. 211(C), pages 338-351.
    24. Cylus, Jonathan & Papanicolas, Irene, 2015. "An analysis of perceived access to health care in Europe: How universal is universal coverage?," Health Policy, Elsevier, vol. 119(9), pages 1133-1144.

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