Abbreviated Name:
Population impoverished due to out-of-pocket health expenditure
Indicator Name:
Population impoverished due to out-of-pocket health expenditure
Domain:
Health System Response/ Health financing
Related Terms:
Out-of-pocket health payments; catastrophic health expenditure
Definition:
Proportion of the population where a household’s total consumption expenditure or income including household expenditure on health is greater than the poverty line but the household’s total consumption expenditure or income excluding household expenditure on health is below the poverty line
Measurment Method:
Household’s expenditure on health are defined as formal and informal payments made at the time of getting any type of care (preventive, curative, rehabilitative, palliative or long term care) provided by any type of provider. These payments include the part not covered by a third party like an insurer. With this definition they correspond to out-of-pocket payments (OOPs–SHA 2011). The Headcount ratio of impoverishing health expenditure aim to capture the impact of OOPs on poverty. The idea is simple, OOPs result in fewer economic resources to spend on other basic necessities identified by a poverty line to such an extent that in some cases a household’s position in relation to such pre-defined poverty line before and after spending out-of-pocket on health changes.
Impoverishment can be computed as the difference in the incidence of poverty based on household’s total consumption expenditure or income gross and net of out-of-pocket payments. Household’s sample weight multiplied by the household size is used to obtain representative numbers per person. If the sample is self-weighting t only the household size is used as the weight.
Poverty lines can be defined in different ways. At the global level to demonstrate the interdependency between SDG target 1.1 the eradication of extreme poverty and SDG target 3.8 (universal coverage), the international poverty line of $1.9 per day per capita using 2011 purchasing power parities (PPPs) for private consumption shall be used. Such a line tends to be too low for most upper-middle income and high income countries. It might therefore be useful to use a poverty line defined as 50% of median daily household consumption or income per capita. This type of relative line comes closest to the one used by OECD.
Ultimately the choice of the poverty line should be tailored to inform evidence-based policy changes at global, regional and national levels. The use of national and regional poverty is critical to fully understand the impact of OOPs on poverty.
This indicator is not an official SDG indicator per se but links SDG goal 3.8 on Universal health coverage directly to the first SDG goal on poverty eradication. It is an important complement to SDG indicator 3.8.2. To fully understand progress towards UHC it needs to be monitored jointly with SDG indicator 3.8.1
Impoverishment can be computed as the difference in the incidence of poverty based on household’s total consumption expenditure or income gross and net of out-of-pocket payments. Household’s sample weight multiplied by the household size is used to obtain representative numbers per person. If the sample is self-weighting t only the household size is used as the weight.
Poverty lines can be defined in different ways. At the global level to demonstrate the interdependency between SDG target 1.1 the eradication of extreme poverty and SDG target 3.8 (universal coverage), the international poverty line of $1.9 per day per capita using 2011 purchasing power parities (PPPs) for private consumption shall be used. Such a line tends to be too low for most upper-middle income and high income countries. It might therefore be useful to use a poverty line defined as 50% of median daily household consumption or income per capita. This type of relative line comes closest to the one used by OECD.
Ultimately the choice of the poverty line should be tailored to inform evidence-based policy changes at global, regional and national levels. The use of national and regional poverty is critical to fully understand the impact of OOPs on poverty.
This indicator is not an official SDG indicator per se but links SDG goal 3.8 on Universal health coverage directly to the first SDG goal on poverty eradication. It is an important complement to SDG indicator 3.8.2. To fully understand progress towards UHC it needs to be monitored jointly with SDG indicator 3.8.1
Numerator:
Total number of people whose household’s total consumption expenditure or income including household expenditure on health is greater than the poverty line but the household’s total consumption expenditure or income excluding household expenditure on health is below the poverty line.
Denominator
Total number of people.
Estimation method:
NA
Disaggregation:
Subnational variables available in survey data. Information on household location (urban vs rural); the gender, age and education of the head of the household; and other socio-economic variables are useful for equity analysis
Primary data sources:
HH surveys: household total expenditure and household expenditures
on health, from a national population-based survey; the three most common data sources are household budget surveys (HBS), household income and expenditure surveys (HIES), socio-economic or living standards surveys. These surveys are typically implemented by or in close collaboration with national statistical bureaus.
Datasets from these surveys are always available to MoH, typically obtained through technical contacts in-country but may also be available publically or for direct purchase.
on health, from a national population-based survey; the three most common data sources are household budget surveys (HBS), household income and expenditure surveys (HIES), socio-economic or living standards surveys. These surveys are typically implemented by or in close collaboration with national statistical bureaus.
Datasets from these surveys are always available to MoH, typically obtained through technical contacts in-country but may also be available publically or for direct purchase.
Alternate data sources:
Total number of people whose household’s total consumption expenditure or income including household expenditure on health is greater than the poverty line but the household’s total consumption expenditure or income excluding household expenditure on health is below the poverty line.
Measurment frequency:
Annual