Health and social protection

Work on health and social protection in Future Health Systems is based on two assumptions:

• That it should be set within the considerable body of recent work on social protection in order to build on relevant existing knowledge;
• That it should emphasise the special and distinct character of ‘health shocks’.

Apart from the obvious advantages of working within a broader conceptual and experiential context, evidence suggests that poor people themselves view health shocks as simply one more burden with which they have to cope. It is often the simultaneous or cumulative impacts of a diversity of adverse events that drive individuals, households and families into poverty.

On the other hand, due regard needs to be given to the special nature of health shocks and the multiple pathways by which they can impact well-being. Different illnesses have a bewildering array of diverse characteristics – acute, recurrent, chronic, progressive, disabling, life-threatening, stigmatising, curable, incurable, manageable, etc. Their impact will depend not only on these characteristics but also on those of the individual falling ill (age, sex, education, etc.), the household of which they are a member (size, composition, assets, etc.), their position in that household (income earner, child, elderly relative, etc.), the community in which that household is located and their broader family and social networks.
Whether impoverishment results will depend to a considerable extent both on the effectiveness of formal or informal mechanisms intended to assist distressed households and local opportunities for income generation.

The functioning of the health system and, in particular, the availability of safe, effective, affordable and trusted care may also play a major role in determining outcomes. Social protection interventions in health have tended to focus on supporting the poor in meeting the cost of inpatient care. We would argue that this approach, while not to be discouraged, must be seen as addressing only one aspect of a much wider problem.

Further reading

Lucas H, Bloom G and Sabates-Wheeler Protecting the poor against health shocks

Waters H Protecting the Poor against Shocks: Financial Protection

Edström J Rethinking ‘Vulnerability’ and Social Protection for Children Affected by AIDS

Ozawa S, Walker DG.  An investigation of trust in the context of community-based health insurance schemes in Cambodia: communities’ trust in providers and insurers.  Advances in Health Economics and Health Services Research, Volume 19: Health Care Financing in Low- and Middle-Income Countries.

Bishai DM, Shah NM, Walker DG, Brieger WR, Peters DH. Social franchising to improve quality and access in private health care in developing countries. Harvard Health Policy Review. 2008; 9(1): 184-197.

Chengnian, Xiaoguang F, Zaoli W. Analysis on new cooperative medical scheme operation of East China in 2006. Chinese Health Economics.  2008; 8:

Wang Y.  The policy process and context of the Rural New Cooperative Medical Scheme and Medical Financial Assistance in China.  Issue 23 in the ITM-Antwerp series Studies in Health Services Organisation & Policy.  Antwerp: Institute of Tropical Medicine.  2008.

Y. Xu; X. Zhang; X. Zhu Medical financial assistance in rural China: policy design and implementation Studies in Health Services Organisation and Policy, 2008

Bloom, G., ‘Health and Social Protection: Meeting the Needs of the Very Poor’, background paper for the Chronic Poverty Report 2007/08, Chronic Poverty Research Centre