This paper explores financial risk associated with access to healthcare services in Liberia. It also proposes a method to complement the standard financial risk protection measures in the WHO/World Bank global monitoring framework for Universal Health Coverage (UHC). To do this, besides the standard catastrophic and impoverishing expenditure analyses, the authors measure how many households are forgoing healthcare services. Using the standard measures, findings show that about 2.1% of households were exposed to catastrophic health expenditures (CHE) and 1.6% of these were pushed below the food poverty line in 2014. However, the additional measure shows that the number of households forgoing health care was four times higher than the number of households incurring catastrophic health expenditures. This means that relying on only CHE as a measure of financial risk protection would underestimate the degree of financial risk given that the majority of households forgo care altogether to avoid incurring CHE. This has huge implications for UHC. For example, the financial barrier to quality healthcare services is very high for the most vulnerable who can’t afford care. As such, to accurately track progress towards UHC, policymakers should also consider the number of individuals/households who have had to forgore care because they can’t afford it.
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