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Towards Improved Measurement of Financial Protection in Health

The Issue

How well patients are protected from the financial consequences of illness is a key measure of any health care system. Many health systems, however, fail to provide adequate financial protection to their citizens, leaving millions worldwide exposed to monetary hardships and the threat of impoverishment because of medical expenses. Moreover, the problem may be understated, as conventional indicators do not adequately measure financial protection. 

What the Study Found

Conventional measures of financial security in health are based solely on out-of-pocket medical expenditures, overlooking the fact that poorer people may report very low or no health spending simply because they cannot afford needed services. Such indicators, therefore, may mistakenly minimize the consequences of inadequate financial protection. The authors note, for example, that while estimated rates of catastrophic health spending were similar for Uganda, Greece, and Portugal, evidence suggests a larger share of Uganda's population is not adequately protected against the financial consequences of illness and may forgo important treatments because of costs. According to World Health Organization data, only about 59 percent of 1-year-olds in Uganda received the DTP3 (diphtheria, tetanus, and pertussis) immunization, compared to around 90 percent in Portugal and Greece. 


Using conventional measures of financial protection in health care (e.g., indicators of catastrophic spending) in isolation may lead to erroneous policy decisions. Alternative measures that account for barriers to access, like those used in The Commonwealth Fund's International Health Policy Surveys, can provide a complement to standard indicators. "There is a clear and urgent need to develop better metrics of the level of financial risk protection for sound policymaking in health systems," the authors conclude.

Publication Details



R. Moreno-Serra, C. Millet, and P. C. Smith, "Towards Improved Measurement of Financial Protection in Health," PloS Medicine, Sept. 2011 8(9):e1001087.