Catastrophic health payments : does the equivalence scale matter?

dc.contributor.authorKoch, Steven F.
dc.contributor.emailsteve.koch@up.ac.zaen_ZA
dc.date.accessioned2019-04-17T11:05:44Z
dc.date.issued2018-10
dc.description.abstractWe present a revised method for estimating equivalence scales. Such scales are used to adjust household welfare to account for the size of the household, and are used extensively in the application of the World Health Organization’s (WHO) methodology for the evaluation of catastrophic health payments. Applications of the WHO method are underpinned by early estimates that do not control for household income, and, therefore, are likely to overstate equivalence. Thus, in addition to revising the method, we update the scale estimates for one country, South Africa, using more recent data. South Africa is considered, because the end of Apartheid has led to extensive social and economic changes that have influenced household structure and, presumably, equivalence. We also present information on the possible degree to which earlier estimates are overstated, as well as the effect that has on other components of the WHO method, especially the determinants of out-of-pocket expenditures and catastrophic health payments. We find that, in the worst case, initial estimates could be overstated by as much 46%, leading to the understatement of poverty lines by as much as 17%. Despite these large differences, the average incidence of catastrophe in health expenditure was largely unaffected. Instead, differences in scales affect conclusions related to the determinants of out-of-pocket payments and catastrophic health expenditures, as well as the distribution of catastrophe across household size. Given that South Africa has low levels of catastrophic health expenditure, the effect could be even larger in other countries, and, therefore, we recommend that researchers consider a range of scales, when examining catastrophic health expenditures.en_ZA
dc.description.departmentEconomicsen_ZA
dc.description.embargo2019-10-01
dc.description.librarianhj2019en_ZA
dc.description.urihttp://heapol.oxfordjournals.orgen_ZA
dc.identifier.citationKoch, S.F. 2018, 'Catastrophic health payments : does the equivalence scale matter?', Health Policy and Planning, vol. 33, no. 8, pp. 966–973, https://doi.org/10.1093/heapol/czy072.en_ZA
dc.identifier.issn0268-1080 (print)
dc.identifier.issn1460-2237 (online)
dc.identifier.other10.1093/heapol/czy072
dc.identifier.urihttp://hdl.handle.net/2263/69003
dc.language.isoenen_ZA
dc.publisherOxford University Pressen_ZA
dc.rights© The Author(s) 2018. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Eshre Monographs following peer review. The definitive publisher-authenticated version is : 'Catastrophic health payments : does the equivalence scale matter?', Health Policy and Planning, vol. 33, no. 8, pp. 966–973, https://doi.org/10.1093/heapol/czy072, is available online at: https://academic.oup.com/heapol/article-abstract/33/8/966/5070410?redirectedFrom=fulltexten_ZA
dc.subjectHealth economicsen_ZA
dc.subjectPovertyen_ZA
dc.subjectHealth inequalitiesen_ZA
dc.subjectMedical economicsen_ZA
dc.subjectFooden_ZA
dc.subjectHealth expendituresen_ZA
dc.subjectIncomeen_ZA
dc.subjectSocial welfareen_ZA
dc.subjectSouth Africa (SA)en_ZA
dc.subjectWorld healthen_ZA
dc.subjectEconomicsen_ZA
dc.subjectHealth disparityen_ZA
dc.subjectWeight measurement scalesen_ZA
dc.subjectApartheiden_ZA
dc.titleCatastrophic health payments : does the equivalence scale matter?en_ZA
dc.typePostprint Articleen_ZA

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