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Faculty Workshop Series - Govind Persad

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Speaker: Govind Persad, Johns Hopkins University 

Title: Rethinking financial Risk Protection In Universal Health Coverage

Abstract: The World Health Organization regards protection against financial risk as a central justification for universal health coverage. Many commentators include financial risk protection, unlike other goals like better education or improved governance, among the central aims of the health care system. Financial risk protection has been proposed as a criterion for health system design, health system financing, and priority-setting within the health care system: the WHO gives “fairness of financial contribution,” which includes financial risk protection, the same weight in health system evaluation that it gives to improvement in average population health.

Few have critically examined whether financial risk protection merits this pride of place, or explored how the concept should be defined. In particular, political philosophers and bioethicists, even those engaged in normative examination of health care financing, have not offered a normative account of which financial outcomes we ought to protect people against, what justifies treating financial risk protection as a central goal of the health care system, or how financial risk protection should be balanced against other goals. In the absence of such work, much research has simply assumed the normative importance of some arbitrarily chosen definition of financial risk protection and moved on to examine empirical questions regarding financial risk protection (for instance, whether health care systems fail to protect people from financial losses, and whether universal coverage would prevent those losses).

This paper aims to fill that gap by both identifying the core normative issues that financial risk protection raises and critically examining the normative case for financial risk protection. Part I briefly presents and evaluates the most popular empirical measures of financial risk protection employed in the literature, which define risk protection as protection against impoverishment, protection against large losses of income, and protection against losses of specific goods. Part II discusses and ultimately argues against four core normative commitments that many policymakers and social scientists working on financial risk protection adopt. In particular, I criticize proposals that protect the better-off and those suffering sudden or large financial reversals against financial losses while doing little to help the worse-off or those suffering smaller financial losses.  Part III proposes a new way of thinking about financial risk protection, one which emphasizes those likely to be most disadvantaged by illness and the cost of medical care over a lifetime.


The workshop will be held in Hariri 570, and will begin at 12:00 and continue until 1:30. Lunch will be served. All are welcome. Please inform the director of the institute, Michael Douma (, if you plan to attend.


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Friday, April 21, 2017 - 12:00pm
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