Abstract
ObjectiveTo document the financial protection status of eight countries of the South-East Asian region and to investigate the main components of out-of-pocket expenditure on health care.MethodsWe calculated two financial protection indicators using data from living standards surveys or household income and expenditure surveys in Bangladesh, Bhutan, India, Maldives, Nepal, Sri Lanka, Thailand and Timor-Leste. First, we calculated the incidence of catastrophic health expenditure, defined as the proportion of the population spending more than 10% or 25% of their total household expenditure on health. Second, using World Bank poverty lines, we determined the impoverishing effect of health-care spending by households. We also conducted an analysis of the main components of out-of-pocket expenditure.ResultsAcross countries in this study, 242.7 million people experienced catastrophic health expenditure at the 10% threshold, and 56.4 million at the 25% threshold. We calculated that 58.2 million people were pushed below the extreme poverty line of 1.90 United States dollars (US$) and 64.2 million people below US$ 3.10 (per capita per day values in 2011 purchasing power parity), due to out-of-pocket spending on health. Spending on medicines was the main component of out-of-pocket spending in most of the countries.ConclusionA substantial number of people in South-East Asia experienced financial hardship due to out-of-pocket spending on health. Several countries have introduced policies to make medicines more available, but the finding that out-of-pocket expenditure on medicines remains high indicates that further action is needed to support progress towards universal health coverage.
Highlights
The aim of universal health coverage (UHC), as set out in Transforming our world: the 2030 agenda for sustainable development,[1] is to ensure that all people and communities receive the health care they need, without experiencing financial hardship
The World Health Organization (WHO) South-East Asia Region consists of 11 Member States and almost 2 billion people living in low- and lower-middle income countries
We aimed to investigate the main components of out-of-pocket spending both at national level and by quintiles of total household expenditure
Summary
The aim of universal health coverage (UHC), as set out in Transforming our world: the 2030 agenda for sustainable development,[1] is to ensure that all people and communities receive the health care they need, without experiencing financial hardship. The World Health Organization (WHO) South-East Asia Region consists of 11 Member States and almost 2 billion people living in low- and lower-middle income countries. Population health has progressively improved in recent decades, the Region still lags behind many others, except Africa Region and fragile states elsewhere, and inequities remain.[2] Government spending on health ranges from 0.4% to 2.5% of gross domestic product in all countries of the Region except Maldives and Thailand, lower than what has been suggested as necessary for better performance.[3] As a result, the health financing model relies heavily on out-ofpocket expenditure by households, comprising an estimated 47% of current health expenditure on average in the Region, with a huge variation across countries from 10% to 74%.4 Such a high level of out-of-pocket expenditure implies a heavy financial burden on households.[5,6] the poor may be disproportionately affected due to fewer resources at their disposal; international evidence suggests that the costs of treatment could be prohibitively high for them to access needed health care.[7] The health financing model relies heavily on out-ofpocket expenditure by households, comprising an estimated 47% of current health expenditure on average in the Region, with a huge variation across countries from 10% to 74%.4 Such a high level of out-of-pocket expenditure implies a heavy financial burden on households.[5,6] the poor may be disproportionately affected due to fewer resources at their disposal; international evidence suggests that the costs of treatment could be prohibitively high for them to access needed health care.[7]
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