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Reassessing catastrophic health-care payments with a Nigerian case study

机译：通过尼日利亚案例研究重新评估灾难性的医疗保健费用

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摘要

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.
机译：卫生筹资改革最近在发展中国家引起了很多关注。但是，自付费用仍然很大。当此类支付涉及的支出超过家庭资源的一定比例时，通常被认为是“灾难性的”。有关灾难定义的研究文献提出了许多重要问题，因此，在这一问题上仍然缺乏共识。本文认为，有必要研究什么可能构成灾难性支付的公平指数，该指数明确承认垂直边际原则中反映的收入边际效用递减。它建议使用与等级相关的权重，以允许收入阶梯上的个体之间的门槛支付水平发生变化。然后将这些应用于尼日利亚数据集。结果表明，使用固定阈值（无论是否通过浓度指数加权）获得的灾难性人数（正差距）低于（高于）等级相关阈值所预测的数量。从根本上说，需要进行更多的研究工作，以使本文中的思想更进一步，并在各种不同的情况下研究灾难的公平构造是什么样的。

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