Catastrophic payments for health care in Asia.
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.
van Doorslaer
Eddy
E
Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands. vandoorslaer@few.eur.nl
O'Donnell
Owen
O
Rannan-Eliya
Ravindra P
RP
Somanathan
Aparnaa
A
Adhikari
Shiva Raj
SR
Garg
Charu C
CC
Harbianto
Deni
D
Herrin
Alejandro N
AN
Huq
Mohammed Nazmul
MN
Ibragimova
Shamsia
S
Karan
Anup
A
Lee
Tae-Jin
TJ
Leung
Gabriel M
GM
Lu
Jui-Fen Rachel
JF
Ng
Chiu Wan
CW
Pande
Badri Raj
BR
Racelis
Rachel
R
Tao
Sihai
S
Tin
Keith
K
Tisayaticom
Kanjana
K
Trisnantoro
Laksono
L
Vasavid
Chitpranee
C
Zhao
Yuxin
Y
D001208:Asia; D002017:Budgets; D002388:Catastrophic Illness / Q000191:economics*; D005191:Family Characteristics; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans