Medicines coverage and community-based health insurance in low-income countries

Abstract

ObjectivesThe 2004 International Conference on Improving Use of Medicines recommended that emerging and expanding health insurances in low-income countries focus on improving access to and use of medicines. In recent years, Community-based Health Insurance (CHI) schemes have multiplied, with mounting evidence of their positive effects on financial protection and resource mobilization for healthcare in poor settings. Using literature review and qualitative interviews, this paper investigates whether and how CHI expands access to medicines in low-income countries.MethodsWe used three complementary data collection approaches: (1) analysis of WHO National Health Accounts (NHA) and available results from the World Health Survey (WHS); (2) review of peer-reviewed articles published since 2002 and documents posted online by national insurance programs and international organizations; (3) structured interviews of CHI managers about key issues related to medicines benefit packages in Lao PDR and Rwanda.ResultsIn low-income countries, only two percent of WHS respondents with voluntary insurance belong to the lowest income quintile, suggesting very low CHI penetration among the poor. Yet according to the WHS, medicines are the largest reported component of out-of-pocket payments for healthcare in these countries (median 41.7%) and this proportion is inversely associated with income quintile. Publications have mentioned over a thousand CHI schemes in 19 low-income countries, usually without in-depth description of the type, extent, or adequacy of medicines coverage. Evidence from the literature is scarce about how coverage affects medicines utilization or how schemes use cost-containment tools like co-payments and formularies. On the other hand, interviews found that medicines may represent up to 80% of CHI expenditures.ConclusionThis paper highlights the paucity of evidence about medicines coverage in CHI. Given the policy commitment to expand CHI in several countries (e.g. Rwanda, Lao PDR) and the potential of CHI to improve medicines access and use, systematic research is needed on medicine benefits and their performance, including the impacts of CHI on access to, affordability, and use of medicines at the household level.

Associação entre prática de atividade física no tempo de lazer e medicação permanente em adultos de uma região de baixo nível socioeconômico

“…Although the national public health system is responsible for most of the total medication expenditure, especially for poor people, a population-based study conducted in Florianópolis, Santa Catarina, showed that 3.1% of the richest people allocate more than 15% of their income to the purchase of medicines, whereas this frequency is 9.6% among the poorest 3 . In agreement with this result, a systematic review demonstrated that the financial impact of the purchase of medicines on the household budget is greater among low-income people 2 . With respect to leisure-time physical activity, this scenario is not different.…”

“…This scenario is a matter of concern especially among individuals of low socioeconomic status, since expenses with medicines account for most of their private health expenditure. Furthermore, medication spending as a share of total expenditure on health is inversely proportional to income 2 . This scenario tends to increase health inequalities, with consequent health and even greater socioeconomic risks for poorer families 3 .…”

Desigualdades socioeconômicas nos gastos e comprometimento da renda com medicamentos no Sul do Brasil

“…The medicines' weight in the total health expenditures is inversely proportional to income, according to a literature review in 54 low-income countries. 16 Similarly, medicines have had the largest share of responsibility for health expenditures in Brazil, reaching approximately 47% of the total expenditures. 3 Income committed to drug expenditure, especially when it is not planned, can lead families to even greater health risks, like the reduction in the purchase of food products, and make them become more susceptible to health problems, or, by the economic order, make families become poorer or even indigent.…”

Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil

“…Entre os setores mais pobres da população, o dispêndio com medicamentos representa a maior parcela dos gastos privados em saúde, e estes gastos se dão de maneira inversamente proporcional à renda, conforme revisão da literatura em 54 países de baixa renda 22,25 .…”