Academic journal article Bulletin of the World Health Organization

Estimating Health Expenditure Shares from Household Surveys/ Estimer la Part Des Depenses De Sante a Partir D'enquetes Sur Les Menages/ Estimacion De Los Porcentajes De Gasto Sanitario Provenientes De Encuestas En Los Hogares

Academic journal article Bulletin of the World Health Organization

Estimating Health Expenditure Shares from Household Surveys/ Estimer la Part Des Depenses De Sante a Partir D'enquetes Sur Les Menages/ Estimacion De Los Porcentajes De Gasto Sanitario Provenientes De Encuestas En Los Hogares

Article excerpt

Introduction

Health expenditure share, or the percentage of the household expenditure spent on health care, is an important variable in health financing research. (1) This figure is used to determine the number of households incurring catastrophic health expenditures and, in many countries, to derive the estimates of private health expenditure reported in national health accounts. (2-5) Studies have shown that health expenditure share estimates derived from household expenditure surveys have problems with "reliability, validity, and comparability". (6,7) For example, two nationally representative surveys conducted in the Philippines in 2003 reported widely different health expenditure shares--1.3% and 7.7%. One wonders which of the two estimates is a more accurate reflection of reality.

An extensive literature exists on the sources of bias in surveys. (8-10) However, few studies have explored how biases affect estimates of out-of-pocket household health expenditure. Lu et al. (6) examined how the number of questions on health expenditure and the recall period of a survey affected estimates of household out-of-pocket payments and catastrophic expenditure on health. Their study analysed data from the World Health Surveys (WHS) for 43 countries and from the Living Standards Measurement Survey (LSMS) for three countries. They found that estimates of health spending were lower when the survey had fewer questions and that the estimates were higher when the recall period was shorter. Heijink et al. (7) conducted an exhaustive review of the evidence surrounding measurement errors in self-reported household expenditure and health expenditure. They also collected 90 household expenditure surveys from the International Household Survey Network (IHSN). Their findings concurred with those of Lu et al.: households reported higher health expenditures when more questions were asked. The authors reported that the influence of the recall period was unclear, but that the mode of data collection, such as a diary versus face-to-face interviews, did affect the estimates. Most of the studies identified by Heijink et al. (7) concluded that diaries yielded lower expenditure figures; (11,12) one study showed conflicting results. (13) Heijink et al. also suggested that the questionnaire's structure affects the results. (7) In some surveys, health expenditure questions are included within the health module, whereas in others they are placed within the household expenditure module.

As noted, previous studies have identified the direction of the biases inherent in health expenditure share estimates. Our study, however, is the first to quantify the effect of these biases. We analyse multiple surveys per country or territory and show how the estimated share of the household expenditure devoted to health (i.e. health expenditure share) would have varied if survey instruments with different characteristics had been employed. Our contribution makes it possible for analysts to compare health expenditure share estimates across surveys. At the end of the paper we raise some points to be considered when conducting cross-country comparisons of household survey data.

Methods

We conducted an exhaustive search of all surveys that reported information on health expenditure and total household expenditure. First we identified the data sources used by the World Health Organization to estimate out-of-pocket expenditure in its Global Health Expenditure Database. We identified a total of 719 household expenditure surveys. However, to conduct our analysis, we needed both the survey questionnaire and microdata (or a report) illustrating how to calculate the health expenditure share for that particular instrument. To obtain this information for the 719 surveys, we looked up the questionnaires, documentation reports and microdata in the IHSN, the Global Health Data Exchange and the web sites of statistical offices and the health ministry of each country or territory. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.