title: Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data.
abstract: BACKGROUND
  Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care.
  
  
  METHODS
  We obtained data on payments for health care from nationally representative surveys, and subtracted these payments from total household resources. We then calculated the number of individuals with less than the internationally accepted threshold of absolute poverty (US1 dollar per head per day) after making health payments. We also assessed the effect of health-care payments on the poverty gap--the amount by which household resources fell short of the 1 dollar poverty line in these countries.
  
  
  RESULTS
  Our estimate of the overall prevalence of absolute poverty in these countries was 14% higher than conventional estimates that do not take account of out-of-pocket payments for health care. We calculated that an additional 2.7% of the population under study (78 million people) ended up with less than 1 dollar per day after they had paid for health care. In Bangladesh, China, India, Nepal, and Vietnam, where more than 60% of health-care costs are paid out-of-pocket by households, our estimates of poverty were much higher than conventional figures, ranging from an additional 1.2% of the population in Vietnam to 3.8% in Bangladesh.
  
  
  CONCLUSIONS
  Out-of-pocket health payments exacerbate poverty. Policies to reduce the number of Asians living on less than 1 dollar per day need to include measures to reduce such payments.
authors.affiliation: Department of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, The Netherlands. e.vandoorslaer@erasmusmc.nl
authors.forename: Eddy
authors.initials: E
authors.lastname: van Doorslaer
authors.forename: Owen
authors.initials: O
authors.lastname: O'Donnell
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Rannan-Eliya
authors.forename: Aparnaa
authors.initials: A
authors.lastname: Somanathan
authors.forename: Shiva Raj
authors.initials: SR
authors.lastname: Adhikari
authors.forename: Charu C
authors.initials: CC
authors.lastname: Garg
authors.forename: Deni
authors.initials: D
authors.lastname: Harbianto
authors.forename: Alejandro N
authors.initials: AN
authors.lastname: Herrin
authors.forename: Mohammed Nazmul
authors.initials: MN
authors.lastname: Huq
authors.forename: Shamsia
authors.initials: S
authors.lastname: Ibragimova
authors.forename: Anup
authors.initials: A
authors.lastname: Karan
authors.forename: Chiu Wan
authors.initials: CW
authors.lastname: Ng
authors.forename: Badri Raj
authors.initials: BR
authors.lastname: Pande
authors.forename: Rachel
authors.initials: R
authors.lastname: Racelis
authors.forename: Sihai
authors.initials: S
authors.lastname: Tao
authors.forename: Keith
authors.initials: K
authors.lastname: Tin
authors.forename: Kanjana
authors.initials: K
authors.lastname: Tisayaticom
authors.forename: Laksono
authors.initials: L
authors.lastname: Trisnantoro
authors.forename: Chitpranee
authors.initials: C
authors.lastname: Vasavid
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D001208:Asia; D003625:Data Collection; D005102:Health Expenditures; D006801:Humans; D011203:Poverty / Q000145:classification* / Q000191:economics