Catastrophic payments for health care in Asia

TLDR

Out‑of‑pocket payments are the principal means of financing health care across much of Asia, and in many low‑ and middle‑income countries the wealthier households spend a larger share of resources on health, whereas in some countries the poorest also face catastrophic costs. The study estimates the magnitude and distribution of catastrophic out‑of‑pocket payments for health care in fourteen Asian countries and territories covering 81 % of the population. Catastrophic payments are defined as those absorbing a large fraction of household resources, and the analysis focuses on these payments across the selected countries. Bangladesh, China, India, Nepal and Vietnam exhibit the highest incidence of catastrophic payments, whereas Sri Lanka, Thailand and Malaysia show lower catastrophic impacts. © 2007 John Wiley & Sons, Ltd.

Abstract

Abstract Out‐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. Copyright © 2007 John Wiley & Sons, Ltd.