title: Healthcare financing in Yemen.
abstract: Yemen is a low-middle-income country where more than half of the population live in rural areas and lack access to the most basic health care. At US$40 per capita, Yemen's annual total health expenditure (THE) is among the lowest worldwide. This study analyses the preconditions and options for implementing basic social health protection in Yemen. It reveals a four-tiered healthcare system characterised by high geographic and financial access barriers mainly for the poor. Out-of-pocket payments constitute 55% of THE, and cost-sharing exemption schemes are not well organised. Resource-allocation practices are inequitable because about 30% of THE gets spent on treatment abroad for a small number of patients, mainly from better-off families. Against the background of a lack of social health protection, a series of small-scale and often informal solidarity schemes have developed, and a number of public and private companies have set up health benefit schemes for their employees. Employment-based schemes usually provide reasonable health care at an average annual cost of YR44 000 (US$200) per employee. In contrast, civil servants contribute to a mandatory health-insurance scheme without receiving any additional health benefits in return. A number of options for initiating a pathway towards a universal health-insurance system are discussed.
authors.affiliation: Public Health Research Group, Social Science Research Centre, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Holst
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gericke
mesh_terms: D002388:Catastrophic Illness / Q000191:economics; D017047:Cost Sharing; D003906:Developing Countries / Q000191:economics; D005382:Financing, Personal; D018166:Health Care Reform / Q000458:organization & administration; D005102:Health Expenditures; D061889:Healthcare Financing; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration; D017149:Private Sector / Q000191:economics; D015006:Yemen