title: Catastrophic payments for health care in Asia.
abstract: 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.
authors.affiliation: Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands. vandoorslaer@few.eur.nl
authors.forename: Eddy
authors.initials: E
authors.lastname: van Doorslaer
authors.forename: Owen
authors.initials: O
authors.lastname: O'Donnell
authors.forename: Ravindra 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: Tae-Jin
authors.initials: TJ
authors.lastname: Lee
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
authors.forename: Jui-Fen Rachel
authors.initials: JF
authors.lastname: Lu
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; D002017:Budgets; D002388:Catastrophic Illness / Q000191:economics*; D005191:Family Characteristics; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans