Immpact Toolkit: Module 4
Version 2
Household Costs Survey
The economic evaluation of a health care intervention can be pursued from a number of perspectives. Typically, the viewpoint of the health service will be important, not least because it is the primary focus of policy-makers. However, economists argue that ideally economic evaluation should adopt a so-called 'societal perspective' (Drummond et al, 1997). The principle is that a cost is a cost, regardless of who bears that cost, and a benefit is a benefit, regardless of who enjoys that benefit. Accordingly, if we are to capture all the costs involved in health care, the costs to households of accessing care should be included in addition to the costs incurred by the health service.
Another major rationale for devoting effort to identifying and measuring the household costs of health care is that it enables the financial barriers to accessing care to be quantified (Borghi et al, 2003; Wagstaff and van Doorslaer, 2003). Many interventions have foundered because they have ignored or underestimated the financial barriers confronting households.