Population with impoverishing health expenditures, at the 2011 PPP $3.20 a day poverty line

Percent

Health system

The proportion of the population pushed further below the poverty line by household health expenditures corresponds to the proportion of poor people spending any amount on health out-of-pocket in the total population. The poor are identified as those people living in households with total household consumption or income inclusive of any health spending below the poverty line. The household’s sample weight multiplied by the household size is used to obtain representative numbers per person. If the sample is self-weighting, then only the household size is used as the weight. The international poverty line of $3.20 a day per capita in 2011 purchasing power parity (PPP) is used (shown as $3.20-a-day). International poverty lines are converted to local currency units (LCUs) using 2011 purchasing power parity (PPP) exchange rates and consumer price indices (CPIs). Household consumption or income, out-of-pocket expenditures on health, and poverty lines are all measured by their daily value per capita.

Impoverishing health spending, Financial hardship, Financial protection, Out-of-pocket expenditure

Global, regional, national, place of residence (rural, urban)

Impact

The proportion of the population pushed further below the poverty line by household health expenditures is computed as the ratio of the number of poor people spending any amount on health out-of-pocket in the total population. These poor people live in a household with consumption or income levels already below the poverty line before health payments and are thus further impoverished when incurring health out-of-pocket payments. The poor are identified as those people living in households with total household consumption or income inclusive of any out-of-pocket health spending below the poverty line. For global monitoring, international poverty lines are used. The international poverty line of $3.20-a-day is converted to local currency units (LCUs) using 2011 purchasing power parity (PPP) exchange rates and consumer price indices (CPIs). Household expenditure on health is defined as formal and informal payments made at the time of getting any type of care (promotive, curative, rehabilitative, palliative or long-term care) provided by any type of provider. These payments include the part not covered by a third party such as the government, health insurance fund or private insurance but exclude insurance premiums as well as any reimbursement by a third party. They might be financed by income, including remittance, savings, or borrowings. With this definition, health expenditures are labelled Out-Of-Pocket (OOP) payments in the classification of health care financing schemes (HF) of the International Classification for Health Accounts (ICHA). The $3.20-a-day poverty line in the 2011 PPP corresponds to the median national poverty line of lower-middle-income countries. With this poverty line, the proportion of the population pushed further into poverty by out-of-pocket payments is close to or equal to zero in upper-middle-income and high-income countries. 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 lines is critical to fully understand the impact of out-of-pocket payments on poverty at national and regional levels. The population pushed further below the poverty line can be disaggregated by area of residence (“rural”/”urban”). The total population incurring impoverishing health expenditures correspond to those pushed and pushed further* into poverty by household health expenditures which can be further disaggregated by the age of the head of the household, sex of the head of the household and age composition of the household. Indicators of impoverishment due to spending on health are not part of the official SDG indicator of Universal Health Coverage (UHC) per se but relate UHC to the first SDG goal, namely ending poverty in all its forms everywhere. * See the metadata for the population pushed further into poverty by household health expenditures.

The global and regional incidence of the proportion of the population pushed further below the $3.20-a-day poverty line by household health expenditures is estimated as the population-weighted average of the country-level share of people pushed further into poverty by health expenditures for a reference year. Incidence at the country level for the reference year is estimated using different methods depending upon the availability of information for that country around or at the reference year (T*). In countries for which there is an observed incidence rate of further impoverishment by health expenditures at the $3.20-a-day poverty line in the reference year T*, this point is used. When there are at least two observed incidence rates of the population further impoverished by health expenditures around the reference over a 5-year window around the reference year [T*–5; T*+5], linear interpolation is used to project the value of the proportion of “the population pushed further below the $3.20-a-day poverty line by household health expenditures” in the reference year. If these conditions are not met but there are at least two observed incidence rates of the population further impoverished by health expenditures, a multilevel model of the rate of the population further impoverished below the $3.20-a-day poverty line by health expenditures is estimated using the aggregate share of OOP over total consumption expenditure and the share of the population under the $3.20-a-day poverty line as the explanatory variables if that information is available. If such information is not available or there aren’t two incidence rates of the population further impoverished by health expenditure, the incidence rate is imputed in the reference year with the median incidence in that year among countries within the same income group (low, lower-middle, upper-middle, or high) as classified by the World Bank. If such classification is missing, the regional median impoverishment value is used. The regional classification used for the imputation is M49 level 1. The country estimates for the reference year are then aggregated up to the regional and global levels to get the number of people pushed below the $3.20-a-day poverty line by household health expenditures. Global and regional aggregates are expressed in million or per cent of the relevant population. Global and regional rates are calculated by expressing these numbers as a share of the relevant population, equivalent to taking a population-weighted average of the relevant country rates.

Every 2-3 years

Every 1–5 years depending on implementation of population-based household expenditure surveys led by national statistics offices

uhc_stats@who.int

Dr. Gabriela Flores

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