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Valuing Protection against Health-Related Financial Risks

  • Jonathan Skinner (a1), Kalipso Chalkidou (a2) and Dean T. Jamison (a3)

There is strong interest in both developing and developed countries toward expanding health insurance coverage. How should the benefits, and costs, of expanded coverage be measured? While the value of reducing the financial risks that result from insurance coverage have long been recognized, there has been less attention in how best to measure such benefits. In this paper, we first provide a framework for assessing the financial value from health insurance. We focus on three distinct potential benefits: Pooling the risk of unexpected medical expenditures between healthy and sick households, redistributing resources from high- to low-income recipients and smoothing consumption over time. We then use this theoretical framework and an illustrative example to provide practical guidelines for benefit-cost analysis in capturing the full benefits (and costs) of expanding health insurance coverage. We conclude by considering other potential financial effects of broad insurance coverage, such as the ability to consolidate purchases and thus lower input prices.

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Akazili, James, Welaga, Paul, Bawah, Ayaga, Achana, Fabian S., and Oduro, Abraham et al. . 2014. “Is Ghana’s Pro-Poor Health Insurance Scheme Really for the Poor? Evidence from Northern Ghana.” BMC Health Services Research, 14(1): 637.
Asaria, Miqdad, Griffin, Susan, Cookson, Richard, Whyte, Sophie, and Tappenden, Paul. 2015. “Distributional CostEffectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme.” Health Economics, 24(6): 742754.
Ataguba, John E., Akazili, James, and Di McIntyre. 2011. “Socioeconomic-related Health Inequality in South Africa: Evidence from General Household Surveys.” International Journal for Equity in Health, 10(1): 48.
Arrow, Kenneth J. 1963. “Uncertainty and the Welfare Economics of Medical Care.” The American Economic Review, 53(5): 941973.
Baicker, Katherine and Levy, Helen. 2012. “The Insurance Value of Medicare.” New England Journal of Medicine, 367(19): 17731775.
Baicker, Katherine, Shepard, Mark, and Skinner, Jonathan. 2013. “Public Financing of the Medicare Program will Make its Uniform Structure Increasingly Costly to Sustain.” Health Affairs, 32(5): 882890.
Baily, Martin Neil. 1978. “Some Aspects of Optimal Unemployment Insurance.” Journal of Public Economics, 10(3): 379402.
Barnett, Susan and Brooks, Ray. 2010. “China: Does Government Health and Education Spending Boost Consumption?” International Monetary Fund. Working Paper 10/16.
Brot-Goldberg, Zarek C., Chandra, Amitabh, Handel, Benjamin R., and Kolstad, Jonathan T.. 2017. “What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics.” The Quarterly Journal of Economics, 132(3): 12611318.
Brown, Jeffrey, Casey, Marcus D., and Mitchell, Olivia. 2007. “Who Values the Social Security Annuity? New Evidence on the Annuity Puzzle”. National Bureau of Economic Research.
Castro-Leal, Florencia, Dayton, Julia, Demery, Lionel, and Mehra, Kalpana. 1999. “Public Social Spending in Africa: Do the Poor Benefit?The World Bank Research Observer, 14(1): 4972.
Chetty, Raj. 2006. “A General Formula for the Optimal level of Social Insurance.” Journal of Public Economics, 90(10–11): 18791901.
Chetty, Raj. 2009. “Sufficient Statistics for Welfare Analysis: A Bridge between Structural and Reduced-Form Methods.” Annual Review of Economics, 1(1): 451488.
Chetty, Raj and Looney, Adam. 2006. “Consumption Smoothing and the Welfare Consequences of Social Insurance in Developing Economies.” Journal of Public Economics, 90(12): 23512356.
Cohen, Jessica, Dupas, Pascaline, and Schaner, Simone. 2015. “Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial.” American Economic Review, 105(2): 609645.
Currie, Janet and Gahvari, Firouz. 2008. “Transfers in Cash and In-Kind: Theory Meets the Data.” Journal of Economic Literature, 46(2): 333383.
Desai, Raj. 2017. “Rethinking the Universalism Versus Targeting Debate”. Future Development (Blog), Brookings Institution.
The Economist. 2018. “Universal Health Care, Worldwide, is Within Reach. The Case for it is a Powerful One Including in Poor Countries”. Available at April 26 2018).
Fan, Victoria Y. and Savedoff, William D.. 2014. “The Health Financing Transition: A Conceptual Framework and Empirical Evidence.” Social Science & Medicine, 105(March 1): 112121.
Feldman, Roger and Dowd, Bryan. 1991. “A New Estimate of the Welfare Loss of Excess Health Insurance.” American Economic Review, 81(1): 297301.
Finkelstein, Amy and McKnight, Robin. 2008. “What did Medicare do? The Initial Impact of Medicare on Mortality and Out of Pocket Medical Spending.” Journal of Public Economics, 92(7): 16441668.
Finkelstein, Amy, Taubman, Sarah, Wright, Bill, Bernstein, Mira, and Gruber, Jonathan et al. . 2012. “The Oregon Health Insurance Experiment: Evidence from the First Year.” The Quarterly Journal of Economics, 127(3): 10571106.
Finkelstein, Amy, F. P. Luttmer, Erzo, and Notowidigdo, Matthew J.. 2013. “What Good is Wealth Without Health? The Effect of Health on the Marginal Utility of Consumption.” Journal of the European Economic Association, 11(1): 221258.
Fleurbaey, Marc, Luchini, Stéphane, Muller, Christophe, and Schokkaert, Erik. 2012. “Equivalent Income and Fair Evaluation of Health Care.” Health Economics, 22(6): 711729.
Flores, Gabriela and O’Donnell, Owen. 2016. “Catastrophic Medical Expenditure Risk.” Journal of Health Economics, 46(3): 115.
Galbraith, John K. 1952. American Capitalism: The Concept of Countervailing Power. New Brunswick New Jersey: Houghton Mifflin.
Gertler, Paul and Gruber, Jonathan. 2002. “Insuring Consumption against Illness.” American Economic Review, 92(1): 5170.
Ghebreyesus, Tedros A. 2017. “All Roads Lead to Universal Health Coverage. Commentary.” The Lancet, 5(9): e839e840.
Gqirana, Thulani. 2016. “Private Healthcare a ‘Sick Situation’ – Motsoaledi. News24 (South Africa)”.
Hammitt, James K. 2017. “Extrapolating the Value Per Statistical Life Between Populations: Theoretical Implications.” Journal of Benefit-Cost Analysis, 8(2): 215225.
Hammer, Jeffrey. 2015. “Why Advocating Universal Free Primary Health Care is Irresponsible at Best”. Future Development (Blog), Brookings.
Hubbard, R. Glenn and Judd, Kenneth L.. 1987. “Social Security and Individual Welfare: Precautionary Saving, Borrowing Constraints, and the Payroll Tax.” American Economic Review, 77(4): 630646.
Isaacs, Katelin P. and Choudhury, Sharmila. 2017. “The Growing Gap in Life Expectancy by Income: Recent Evidence and Implications for the Social Security Retirement Age (CRS Report R44846)”. Washington, D.C.: Congressional Research Service.
Jamison, Dean T. 2009. “Cost Effectiveness Analysis: Concepts and Applications.” In Detels, R., McEwen, J., Beaghole, R., Lansang, M. A., and Gulliford, M. (Eds.), Oxford Textbook of Public Health, The Methods of Public Health (5th ed.): 767782. New York: Oxford University Press.
Jamison, Dean T., Alwan, Ala, Mock, Charles N., Nugent, Rachel, Watkins, David, and Adeyi, Olusoji et al. . 2018. “Universal Health Coverage and Intersectoral Action for Health.” In Improving Health and Reducing Poverty: Disease Control Priorities (3rd ed.): (Vol. 9): 121. Washington, D.C.: The World Bank.
Jamison, Dean T., Summers, Lawrence H., Alleyne, George, Arrow, Kenneth J., Berkley, Seth, and Binagwaho, Agnes et al. . 2013. “Global Health 2035: A World Converging within a Generation.” The Lancet, 382(9908): 18981955.
Jan, Stephen, Laba, Tracey-Lea, Essue, Beverley M., Gheorghe, Adrian, and Muhunthan, Janani et al. . 2018. “Action to Address the Household Economic Burden of Non-Communicable Diseases.” The Lancet, 391(10134): 20472058.
King, Gary, Gakidou, Emmanuela, Imai, Kosuke, Lakin, Jason, Moore, Ryan T., and Nall, Clayton et al. . 2009. “Public Policy for the Poor? A Randomized Assessment of the Mexican Universal Health Insurance Programme.” Lancet, 373(9673): 14471454.
Laibson, David. 1997. “Golden Eggs and Hyperbolic Discounting.” Quarterly Journal of Economics, 112(2): 443477.
Lanjouw, Peter, Menno, Pradhan, Fadia, Saadah, Haneen, Sayed, and Robert, Sparrow. 2002. “Poverty, Education and Health in Indonesia: Who Benefits from Public Spending?” In Education and Health Expenditures, and Development: The Cases of Indonesia and Peru: 1778. Paris: OECD Development Centre.
McClellan, Mark and Skinner, Jonathan. 2006. “The Incidence of Medicare.” Journal of Public Economics, 90(1–2): 257276.
Neelsen, Sven and O’Donnell, Owen. 2017. “Progressive Universalism? The Impact of Targeted Coverage on Health Care Access and Expenditures in Peru.” Health Economics, 26(12): e179e203.
Nyman, John A. 1999. “The Value of Health Insurance.” Journal of Health Economics, 18(2): 141152.
O’Donoghue, Ted and Somerville, Jason. 2018. “Modeling Risk Aversion in Economics.” Journal of Economic Perspectives, 32(2): 91114.
Phelps, Charles E., Lakdawalla, Darius N., Basu, Anirban, Drummond, Michael F., Towse, Adrian, and Danzon, Patricia M.. 2018. “Approaches to Aggregation and Decision Making – A Health Economics Approach: An ISPOR Special Task Force Report [5].” Value in Health, 21(2): 146154.
Prada, Sergio I., Soto, Victoria E., Andia, Tatiana S., Vaca, Claudia P., Morales, Álvaro A., Márquez, Sergio R., and Gaviria, Alejandro. 2018. “Higher Pharmaceutical Public Expenditure after Direct Price Control: Improved Access or Induced Demand? The Colombian Case.” Cost Effectiveness and Resource Allocation, 16(1): 8.
Rao, Neethi. 2017. “Realising Universal Health Coverage in Karnataka”. The Wire (October 25th).
Robinson, Lisa A., Hammitt, James K., Jamison, Dean, and Walker, Damian. 2019a. “Conducting Benefit-Cost Analysis in Low- and Middle-Income Countries: Introduction to the Special Issue.” Journal of Benefit-Cost Analysis, 9(4): forthcoming.
Robinson, Lisa A., Hammitt, James K., and O’Keeffe, Lucy. 2019b. “Valuing Mortality Risk Reductions in Global Benefit-Cost Analysis.” Journal of Benefit-Cost Analysis, 9(4): forthcoming.
Robinson, Lisa A. and Hammitt, James K.. 2018a. “Valuing Nonfatal Health Risk Reductions in Global Benefit-Cost Analysis.” Working Paper No. 2, Guidelines for Benefit-Cost Analysis Project. Harvard University.
Robinson, Lisa A. and Hammitt, James K.. with supplement by Matthew Adler, M. D. March 2018b. “Assessing the Distribution of Impacts in Global Benefit-Cost Analysis”. Working Paper No. 3, Guidelines for Benefit-Cost Analysis Project, Harvard University.
Rosen, Daniel, Chalkidou, Kalipso, and Keller, Janeen Madan. 2017. “An Initial Estimation of the Size of Health Commodity Markets in Low- and Middle-Income Countries.” Center for Global Development (December).
Samuelson, Paul A. 1937. “A Note on Measurement of Utility.” Review of Economic Studies, 4(2): 155161.
Skinner, Jonathan. 1988. “Risky Income, Life Cycle Consumption, and Precautionary Savings.” Journal of Monetary Economics, 22(2): 237255.
Skinner, Jonathan S. and Volpp, Kevin G.. 2017. “Replacing the Affordable Care Act: Lessons from Behavioral Economics.” JAMA, 317(19): 19511952.
Smith, Peter C. 2013. “Incorporating Financial Protection into Decision Rules for Publicly Financed Healthcare Treatments.” Health Economics, 22(2): 180193.
Tangcharoensathien, Viroj and Witthayapipopsakul, Woranan. 2018. “Health systems Development in Thailand: A Solid Platform for Successful Implementation of Universal Health Coverage.” The Lancet, 391(10126): 12051222.
Udwadia, Zarir F., Pinto, Lancelot M., and Uplekar, Mukund W.. 2010. “Tuberculosis Management by Private Practitioners in Mumbai, India: Has Anything Changed in Two Decades?PloS One, 5(8): e12023.
van Doorlsaer, Eddie, O’Donnell, Owen, Rannan-Eliya, Ravi P., Somanathan, Aparnaa, and Adhikari, Shiva Raj et al. . 2006. “Effect of Payments for Health Care on Poverty Estimates in 11 Countries in Asia: An Analysis of Household Survey Data.” Lancet, 368(9544): 13571364.
van Doorlsaer, Eddie, O’Donnell, Owen, Rannan, Ravindra P., Aparnaa, Eliya, and Shiva, Somanathan et al. . 2007. “Catastrophic Payments for Health Care in Asia.” Health Economics, 16(11): 11591184.
Verguet, Stéphane, Laxminarayan, Ramanan, and Jamison, Dean T.. 2015. “Universal Public Finance of Tuberculosis Treatment in India: An Extended Cost-Effectiveness Analysis.” Health Economics, 24(3): 318332.
Wagstaff, Adam. 2010. “Measuring Financial Protection in Health.” In Smith, Peter C., Mossialos, Elias, and Papanicolas, Irene E. (Eds.), Performance Measurement for Health System Improvement. Cambridge, England: Cambridge University Press.
Wagstaff, Adam and van Doorslaer, Eddie. 2003. “Catastrophe & Impoverishment in Paying for Health Care: Its Applications to Vietnam 1993–1998.” Health Economics, 12(11): 921934.
Wagstaff, Adam and Lindelow, Magnus. 2008. “Can Insurance Increase Financial Risk? The Curious Case of Health Insurance in China.” Journal of Health Economics, 27(4): 9901005.
WHO (World Health Organization). 2010. World Health Report 2010: Health Systems Financing, the Path to Universal Coverage.
Xu, Ke, Evans, David B., Kawabata, Kei, Zeramdini, Riadh, Klavus, Jan, and Murray, Christopher J. L.. 2003. “Household Catastrophic Health Expenditure: A Multi-Country Analysis.” Lancet, 362(9378): 111117.
Xu, Ke, Evans, David B., Carrin, Guido, Mylena, Ana, Aguilar-Rivera, Philip Musgrove, and Evans, Timothy. 2007. “Protecting Households from Catastrophic Health Spending.” Health Affairs, 26(4): 972983.
Zeckhauser, Richard. 1970. “Medical Insurance: A Case Study of the Tradeoff between Risk Spreading and Appropriate Incentives.” Journal of Economic Theory, 2(1): 1026.
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Journal of Benefit-Cost Analysis
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