Measuring income for catastrophic cost estimates: Limitations and policy implications of current approaches. (October 2018)

• Record Type: Journal Article
• Authors: Sweeney, Sedona; Mukora, Rachel; Candfield, Sophie; Guinness, Lorna; Grant, Alison D.; Vassall, Anna
• Is Part Of: Social science & medicine. Volume 215(2018)
• Page Start: 7
• Page End: 15
• Publication Date: 2018-10
• Subjects: South Africa -- Catastrophic cost -- Coping -- Tuberculosis -- Methods -- Income; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2018.08.041
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: There is increasing global policy interest in estimating catastrophic costs incurred by households because of ill health, and growing need for information on disease-specific household cost data. There are several methodological approaches used to estimate income and no current consensus on the best method for estimating income in the context of a survey at the health facility. We compared six different approaches to estimate catastrophic cost among patients attending a health facility in South Africa. We used patient cost and income data collected June 2014–March 2015 from 66 participants enrolled in a clinical trial in South Africa (TB FastTrack) to explore the variation arising from different income estimation approaches and compared the number of households encountering catastrophic costs derived for each approach. The total proportion of households encountering catastrophic costs varied from 0% to 36%, depending on the estimation method. Self-reported mean annual income was significantly lower than permanent income estimated using an asset linking approach, or income estimated using the national average. A disproportionate number of participants adopting certain coping strategies, including selling assets and taking loans, were unable to provide self-reported income data. We conclude that the rapid methods for estimating income among patients attending a health facility are currently inconsistent. Further research on methods for measuring income, comparing the current recommended methods to 'gold standard' methods in different settings, should be done to identify the most appropriate measurement method. Highlights: Rapid methods for estimating income for catastrophic TB costs are inconsistent. Depending on income estimation approach, 0–36% households faced catastrophic TB costs. Quantitative indicators of catastrophe did not reflect extent of coping strategy use.