Evaluating alternative approaches for improving the measurement of household Out-of-pocket health expenditure: The Indepth-Network household out-of-pocket health expenditure (iHOPE) experimental study in Ghana

Out of pocket health payment (OOPs) has been identified by System of Health Accounts (SHA) as the largest source of health care financing in most low and middle-income countries. This means that most low and middle-income countries will rely on user fees and co-payments to generate revenue, rationalize the use of services, contain health systems costs or improve health system efficiency and service quality. However, the accurate measurement of OOPs has been challenged by several limitations which are attributed to both sampling and non-sampling errors when OOPs are estimated from household surveys, the primary source of information in LICs and LMICs. The incorrect measurement of OOPs can undermine the credibility of current health spending estimates, an otherwise important indicator for tracking UHC, hence there is the need to address these limitations and improve the measurement of OOPs. In this current study, new modules on household health utilization and expenditure were developed by repurposing the existing Ghana Living Standards Survey instrument and further validating these new tools with a ‘gold standard’ (provider data) with the aim of proposing alternative approaches capable of producing reliable data for estimating OOPs in the context of National Health Accounts and for the purpose of monitoring financial protection in health. This was achieved by specifically answering questions on; the structure of the instrument (Type of instrument and overall structure of health expenditure questions), the optimal recall period, the optimal number of items(specificity) and to also share some key lessons, challenges and recommendations in implementing a large validation study in a resource-poor setting.