Catastrophic payments for health care in Asia

Abstract

SUMMARYOut-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low/middle-income countries, the better-off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments.

Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage

“…It implies that inclusion of OOP healthcare spending in consumption expenditure may have a detrimental effect on the socioeconomic ranking of households. In an empirical investigation, van Doorslaer et al (2007) found that the share of OOP payment (of total consumption expenditure) in richer households was much lower than the poorer households (Van Doorslaer et al 2007). It can thus be argued that the possibility of poorer people to get an upper relative ranking is much high as a consequence of OOP healthcare payment.…”

Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

“…8 Various studies have pointed to three objectives for the measurement of CHE: (1) identification of changes in household well-being, (2) assessment of poverty level/low living status at the household level, and (3) evaluation of the performance of available medical insurance plans. 9,10 Overall, each year, about 150 million people are exposed to CHE when paying their health expenditures, of which about 100 million are impoverished people. CHE can occur not necessarily due to the costs of expensive treatment processes; many households with relatively low payments also face financial catastrophes.…”

Catastrophic Effects of Out-of-Pocket Payments for Health Care Using Synthetic Panel Data

“…Naga and Lamiraud (2011) developed a fairly detailed conceptual framework using economic theory which facilitates a clear understanding of existing concepts and methods, and possible limitations. In the empirical front, Van Doorslaer et al (2007), Van Doorslaer et al (2005) and Adhikari, Maskay, and Sharma (2009) developed country level evidences about the incidence of catastrophic expenditure and impoverishment impact in developing countries using national level cross-sectional surveys. Wagstaff et al (2006) used panel data to provide economic consequences of health shocks and health care expenditure.…”

“…In the absence of longitudinal data, OOP health payments in excess of a threshold budget share have been used as a proxy for severe disruptions to household living standards. Regarding this point, Van Doorslaer et al (2007) focus on payments that are catastrophic in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Thus it may be argued that a catastrophic situation may be used to capture a change in household welfare.…”