title: Access to care and medicines, burden of health care expenditures, and risk protection: results from the World Health Survey.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. awagner@hms.harvard.edu
authors.forename: Anita K
authors.initials: AK
authors.lastname: Wagner
authors.forename: Amy Johnson
authors.initials: AJ
authors.lastname: Graves
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Reiss
authors.forename: Robert
authors.initials: R
authors.lastname: Lecates
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D017281:Cost of Illness; D014943:Global Health; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D004364:Pharmaceutical Preparations / Q000600:supply & distribution*; D012044:Regression Analysis
chemical_list: D004364:Pharmaceutical Preparations