Elsevier

Health Policy

Volume 100, Issues 2–3, May 2011, Pages 151-158
Health Policy

Access to care and medicines, burden of health care expenditures, and risk protection: Results from the World Health Survey

https://doi.org/10.1016/j.healthpol.2010.08.004Get rights and content

Abstract

Objectives

We assessed the contribution of health insurance and a functioning public sector to access to care and medicines and household economic burden.

Methods

We used descriptive and logistic regression analyses on 2002/3 World Health Survey data in 70 countries.

Results

Across countries, 286,803 households and 276,362 respondents contributed data. More than 90% of households had access to acute care. However, less than half of respondents with a chronic condition reported access. In 51 low and middle income countries (LMIC), health care expenditures accounted for 13–32% of total 4-week household expenditures. One in four poor households in low income countries incurred potentially catastrophic health care expenses and more than 40% used savings, borrowed money, or sold assets to pay for care. Between 41% and 56% of households in LMIC spent 100% of health care expenditures on medicines. Health insurance and a functioning public sector were both associated with better access to care and lower risk of economic burden.

Conclusion

To improve access, policy makers should improve public sector provision of care, increase health insurance coverage, and expand medicines benefit policies in health insurance systems.

Introduction

Each year, an estimated 44 million households suffer severe financial hardship and 25 million are pushed into poverty because they need to use and pay for health care [1]. When households cannot pay for care from their income, they use savings, borrow money, sell assets, cut food expenditures, or take children out of school, thereby further restricting their short and long-term survival; or they forego needed care because they cannot afford to pay for it, resulting in worse health, less productivity and income, and increased poverty [2].

Protection from the risk of relatively large health care expenditures should improve access to and decrease the financial burden of care. Subsidizing health care costs by insurance schemes (in any form, including national social health insurance systems, mutual benefit societies, and commercial private insurance) is crucial for overcoming financial barriers to care and protecting households from high expenditure burden [3]. To the extent that people use it, a functioning public sector that provides quality care and medicines at low or no cost also protects from risk [2] and may diminish the need for insurance coverage, especially for the poor.

The objectives of this study are to (1) describe access to health care and medicines across countries and (2) assess the relationships among household access to care, economic burden, and risk protection as indicated by insurance coverage and perceptions of public sector care delivery.

Section snippets

Data source and study measures

We used data from the World Health Survey (WHS) [4], [5] conducted by the WHO in 2002 and 2003 in 70 countries. Country samples were drawn from nationally representative sample frames to estimate general population parameters.

We analyzed information on household member demographics, health care needs, health insurance status, household assets, expenditures (by category), and sources used to pay for health care. For each household, the WHS identified one adult respondent. For adult respondents

Results

Across 70 countries (22 low, 18 lower middle, 10 upper middle, and 20 high income, according to 2003 World Bank criteria), [10] 286,803 households and 276,362 adult respondents contributed data. Of those, 100,440 adult respondents lived in 97,578 poor households. Among high income countries, most indicators are available only for a small subset of countries (Slovenia, Spain, and the United Arabic Emirates).

Discussion

The results of our analyses of WHS data from 2002 to 2003 indicate that protecting households from high burden of health care costs is associated with better access to acute and chronic care for adults and children, less risk of potentially catastrophic health care spending, and less use of coping strategies that further deplete household long-term resources. Our results are less clear with respect to medicines access. Specifically, when all household members are insured, access to acute and

Conclusions

To improve access to care and medicines and decrease economic burden of health care expenditures on households, policy makers should improve affordable provision of quality care, increase health insurance coverage, and expand medicines benefit policies in health insurance systems.

Role of the funding source

The World Health Organization (WHO), Geneva, developed and collected the data for the WHS and provided country and survey module level data files to the study team and WHO staff provided answers to requests for clarification. WHO was not involved in the design of the study, analysis, and interpretation of the data.

Disclosure statement

The corresponding author had full access to all data analyzed in the study. All authors confirm that they have no conflicts of interest.

Acknowledgements

We gratefully acknowledge the World Health Organization (WHO), Geneva, which supported this study through funds made available by the United Kingdom Department for International Development. We are grateful for the guidance in understanding World Health Survey data provided by Drs. Somnath Chatterji and Emese Verdes of the Measurement and Health Information Systems Unit at WHO Geneva. We thank Ms. Sarah Lewis for her support in creating the data tables. We gratefully acknowledge the thoughtful

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