Catastrophic Medical Expenditures : Reflections on Three Issues

Wagstaff, Adam

World Bank, Washington, DC

关键词: MEDICAL EXPENSES;    IMPOVERISHMENT;    FINANCIAL HARDSHIP;    FINANCIAL PROTECTION;    MEDICAL CARE COST;   

DOI  :  10.1596/1813-9450-8651
RP-ID  :  WPS8651

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

The ‘basic’ approach to'catastrophic' medical expenses (whereexpenses are related to consumption or income) indicateswhether expenses cause a large percentage reduction inliving standards. By contrast, the 'ability-to-payapproach' (where expenses are related toconsumption or income less actual expenses on nonmedicalnecessities or an allowance for them) does not indicatewhether expenses are large enough to undermine a household’sability to purchase nonmedical necessities. If theindividual is a borrower after a health shock, theincome-based ratio will exceed the consumption-based ratio,while the opposite is true when the individual continues tobe a saver after a health shock. In the first case, bothratios will exceed Flores et al.'s moretheoretically correct ratio, with the income-based ratiooverestimating it by more. But if the individual is still asaver even after a health shock, the income-based ratio willoverestimate Flores et al.'s ratio by less and maynot overestimate it at all. A lifetime money metric utilityapproach can capture the lifetime consequences of copingwith medical expenses. Under certain assumptions, but nototherwise, it and the Flores et al. approaches areidentical, and both are operationalizable without data onhow households finance their medical expenses.