Access to care and medicines, burden of health care expenditures, and risk protection: results from the World Health Survey.
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.
Wagner
Anita K
AK
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. awagner@hms.harvard.edu
Graves
Amy Johnson
AJ
Reiss
Sheila K
SK
Lecates
Robert
R
Zhang
Fang
F
Ross-Degnan
Dennis
D
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
D004364:Pharmaceutical Preparations