TY - JOUR
T1 - Sensitivity of measuring the progress in financial risk protection to survey design and its socioeconomic and demographic determinants
T2 - A case study in Rwanda
AU - Lu, Chunling
AU - Liu, Kai
AU - Li, Lingling
AU - Yang, Yuhong
N1 - Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Reliable and comparable information on households with catastrophic health expenditure (HCHE) is crucial for monitoring and evaluating our progress towards achieving universal financial risk protection. This study aims to investigate the sensitivity of measuring the progress in financial risk protection to survey design and its socioeconomic and demographic determinants. Using the Rwanda Integrated Living Conditions Survey in 2005 and 2010/2011, we derived the level and trend of the percentage of the HCHE using out-of-pocket health spending data derived from (1) a health module with a two-week recall period and six (2005)/seven (2010/2011) survey questions (Method 1) and (2) a consumption module with a four-week/ten-/12-month recall period and 11(2005)/24 (2010/2011) questions (Method 2). Using multilevel logistic regression analysis, we investigated the household socioeconomic and demographic characteristics that affected the sensitivity of estimating the HCHE to survey design. We found that Method 1 generated a significantly higher HCHE estimate (9.2%, 95% confidence interval 8.4%–10.0%) than Method2 (7.4%, 6.6%–8.1%) in 2005 and lower estimate (5.6%, 5.2%–6.1%) than Method 2 (8.2%, 7.6%–8.7%) in 2010/2011. The estimated trends of the HCHE using the two methods were not consistent between the two years. A household's size, its income quintile, having no under-five children, and educational level of its head were positively associated with the consistency of its HCHE status when using the two survey methods. Estimates of the progress in financial risk protection, especially among the most vulnerable households, are sensitive to survey design. These results are robust to various thresholds of catastrophic health spending. Future work must focus on mitigating survey effects through the development of statistical tools.
AB - Reliable and comparable information on households with catastrophic health expenditure (HCHE) is crucial for monitoring and evaluating our progress towards achieving universal financial risk protection. This study aims to investigate the sensitivity of measuring the progress in financial risk protection to survey design and its socioeconomic and demographic determinants. Using the Rwanda Integrated Living Conditions Survey in 2005 and 2010/2011, we derived the level and trend of the percentage of the HCHE using out-of-pocket health spending data derived from (1) a health module with a two-week recall period and six (2005)/seven (2010/2011) survey questions (Method 1) and (2) a consumption module with a four-week/ten-/12-month recall period and 11(2005)/24 (2010/2011) questions (Method 2). Using multilevel logistic regression analysis, we investigated the household socioeconomic and demographic characteristics that affected the sensitivity of estimating the HCHE to survey design. We found that Method 1 generated a significantly higher HCHE estimate (9.2%, 95% confidence interval 8.4%–10.0%) than Method2 (7.4%, 6.6%–8.1%) in 2005 and lower estimate (5.6%, 5.2%–6.1%) than Method 2 (8.2%, 7.6%–8.7%) in 2010/2011. The estimated trends of the HCHE using the two methods were not consistent between the two years. A household's size, its income quintile, having no under-five children, and educational level of its head were positively associated with the consistency of its HCHE status when using the two survey methods. Estimates of the progress in financial risk protection, especially among the most vulnerable households, are sensitive to survey design. These results are robust to various thresholds of catastrophic health spending. Future work must focus on mitigating survey effects through the development of statistical tools.
KW - Developing countries
KW - Financial risk protection
KW - Measuring catastrophic health expenditure
KW - Measuring out-of-pocket health expenditure
KW - Rural Rwanda
KW - Survey design
KW - Survey instruments
UR - http://www.scopus.com/inward/record.url?scp=85011928611&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85011928611&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2017.02.001
DO - 10.1016/j.socscimed.2017.02.001
M3 - Article
C2 - 28189819
AN - SCOPUS:85011928611
SN - 0277-9536
VL - 178
SP - 11
EP - 18
JO - Social Science and Medicine
JF - Social Science and Medicine
ER -