Will (or can) people pay for headache care in a poor country?

Abstract

We asked whether attempts to introduce headache services in poor countries would be futile on grounds of cost and unsustainability. Using data from a population-based survey in the Republic of Georgia, an exemplary poor country with limited health care, and against the background of headache-attributed burden, we report on willingness to pay (WTP) for effective headache treatment. Consecutive households were visited in areas of Tbilisi (urban) and Kakheti (rural), together representative of Georgian habitation. Biologically unrelated adults were interviewed by medical residents using a structured ICHD-II-based diagnostic questionnaire, the MIDAS questionnaire and SF-36. The bidding-game method was employed to assess WTP. Of 1,145 respondents, 50.0% had episodic headache (migraine and/or tension-type headache) and 7.6% had headache on ≥15 days/month, which was not further diagnosed. MIDAS scores were higher in people with headache on ≥15 days/month (mean 11.2) than in those with episodic headache (mean 7.0; P = 0.004). People with headache had worse scores in all SF-36 sub-scales than those without, but no differences were found between headache types. Almost all (93%) respondents with headache reported WTP averaging USD 8 per month for effective headache treatment. WTP did not correlate with headache type or frequency, or with MIDAS or SF-36 scores. Headache is common and headache-attributed burden is high in Georgia, with a profound impact on HRQoL. Even those less affected indicated WTP for effective treatment, if it were available, that would on average cover costs, which locally are low. Headache services in a poor country are potentially sustainable.

Headache‐attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed

“…This last point has another relevance. As in the Republic of Georgia [10], and again as was to be expected, WTP depended on income. Even so, despite their substantially lower income, participants with headache on ≥15 days/month were ready to pay more than those with migraine or TTH.…”

“…LTB, a UK-registered non-governmental organization working in official relations with the World Health Organization (WHO) to conduct the Global Campaign against Headache [6][7][8], has been filling these gaps. In the Republic of Georgia, a small country of the former Soviet Union, headache disorders were found to be highly prevalent and burdensome whilst under-recognized and generally neglected by local medical authorities and physicians [9,10]. This study was followed by a nationwide population-based survey of headache disorders in Russia [11,12], revealing a considerably higher 1-year prevalence of migraine (20.3%) than the global average (estimated at 11% by Stovner et al [5] and more recently at 14.7% by the Global Burden of Disease Study 2010 [1]).…”

Neglected headache: Ignorance, arrogance or insouciance?

“…Failure to consult is a certain barrier to effective care, but the reasons for it need to be examined. In resource-poor Georgia, people with headache are keen to receive help, and even here are not deterred by unwillingness to pay for it (12). But many are unaware of the possibility of effective treatment (9).…”

The Pharmacological Treatment of Migraine in Brazil

“…6,18,37,41 Moreover, although public care is often limited by the unfortunate reality of depending on the availability of free medications to drive the approach and a rarely seen commitment of the medical personnel toward the poor, more efficient lines of treatment should be tried despite the incorrect belief that some would not pay for better care. 18,[42][43][44][45][46][47] Regardless of the findings of this limited study, better study designs uniting efforts of more professionals could lead to a formal public treatment policy for migraine even in developing countries like Brazil.…”

“…In addition, despite the reasonable belief that patients seeking care in the very few tertiary centers of Brazil could expect higher standards of attention and more comprehensive approaches, it was not the case, especially so in public centers, but it was generally encountered in private environments . Moreover, although public care is often limited by the unfortunate reality of depending on the availability of free medications to drive the approach and a rarely seen commitment of the medical personnel toward the poor, more efficient lines of treatment should be tried despite the incorrect belief that some would not pay for better care …”