Protecting Households From Catastrophic Health Spending

Abstract

Many countries rely heavily on patients' out-of-pocket payments to providers to finance their health care systems. This prevents some people from seeking care and results in financial catastrophe and impoverishment for others who do obtain care. Surveys in eightynine countries covering 89 percent of the world's population suggest that 150 million people globally suffer financial catastrophe annually because they pay for health services. Prepayment mechanisms protect people from financial catastrophe, but there is no strong evidence that social health insurance systems offer better or worse protection than tax-based systems do. 1 This can lead to financial hardship and even impoverishment because people are too ill to work. The other side of the coin, less well understood, is that many of those who do seek care suffer financial catastrophe and impoverishment as a result of meeting these costs.2 This occurs in both rich and poor countries. 3This paper focuses on the second effect-the financial consequences of paying for care. It begins by presenting new data from a large data set-116 surveys covering 89 countries-allowing the first global estimates of the extent of catastrophic spending and impoverishment associated with out-of-pocket payments for health services to be made. It then explores health system and population characteristics associated with high levels of catastrophic spending across countries, as the basis for assessing the policy options available to reduce the incidence of financial catastrophe. 4 Discussion and conclusions follow.9 7 2 J u l y /A u g u s t 2 0 0 7 O u t -O f -P o c k e t S p e n d i n g

Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries

“…It may be hypothesized that the poorest subgroup is not able to pay the treatment costs. Health-related expenditures impoverish an estimated 100 million people in LMICs each year (31). An estimated 50 million more suffer from catastrophic health expenditures, commonly defined as expenditures of 10% or more of income (31).…”

“…Health-related expenditures impoverish an estimated 100 million people in LMICs each year (31). An estimated 50 million more suffer from catastrophic health expenditures, commonly defined as expenditures of 10% or more of income (31). Moreover, poorer persons spend a higher proportion of income on health care which might induce (financial) perceived stress (32), in particular following catastrophic expenditure (33) or high out-of-pocket expenditure in areas with no health insurance (33), although this is not universal in all LMICs (34).…”

Financing universal coverage in Kenya – A case study

“…In 2010, there were about 2.3 million admissions in public hospitals which accounted for about 73.2 % of the total number of admissions. Public health facilities registered about 19.2 million outpatient attendances or 87 % of the total attendances, and only a nominal sum of Ksh 20 (approximately USD 0.20) is charged which is inclusive of medication [18]. The maximum amount that can be billed to a patient in a general ward is Ksh15, 000 (USD156) inclusive of all procedures, medication, diagnostic services and ward charges.…”

“…This can be reflected through notable health outcomes in mortality and morbidity which are improving. National vital statistics in 2010 revealed maternal mortality rate to be at 360 per 100,000 live births, infant mortality at 39.0 per 1,000 live births, and expected life expectancy to be 60.0 and 63.1 years for men and women respectively [18]. These outcomes are to be achieved through a comprehensive primary healthcare infrastructure that consists of an extensive rural health service, a referral system that integrates primary care clinics as the gatekeeper to secondary and tertiary care services linking County, National, and general hospitals, as well as heavy government subsidy on public healthcare service provision.…”

“…While Kenya has fared modestly in terms of curative care, there is a critical need to allocate more financing capacity to expand preventive care, in better managing escalating healthcare costs associated with the shifting of disease burden towards chronic noncommunicable diseases (NCD). With NCDs starting to appear in the top ten principal causes of death at government hospitals in 2010 [18] and also the alarming increase in the prevalence of NCDs (i.e. diabetes, obesity, stroke) [28], the effective management of chronic diseases at the population level could significantly affect the sustainability of the existing tax-based financing system.…”