UHC Forward: Towards Universal Health Coverage

Jennifer Prah Ruger argues for a more multi-dimensional assessment of financial protection in health, which can better capture health expenditures and the full burden of health cost burdens.

Inadequate financial protection in health increases people's vulnerability and diminishes well-being, exacerbating inequities and raising moral concerns. Conventional indicators of financial protection such as catastrophic spending and impoverishing spending are too narrowly conceived and likely to underestimate the adverse effects of insufficient financial protection.

Limitations of conventional indicators include failure to capture cost barriers to access, differences in health care utilization by ability to pay, different degrees of financial protection and coverage, “informal” treatment payments, debt financing of health spending, reduced consumption of other household necessities, as well as indirect costs of illness and coping strategies.

A multidimensional financial protection profile can capture interrelated aspects of health expenditure, such as direct and indirect costs of illness, coping strategies used to meet costs, insurance status and utilization, household consumption patterns, and how health costs affect them.