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Ichd 2004 H Pol 6 Catastrophic Health Expenditure
 

Ichd 2004 H Pol 6 Catastrophic Health Expenditure

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Ichd 2004 H Pol 6 Catastrophic Health Expenditure Ichd 2004 H Pol 6 Catastrophic Health Expenditure Presentation Transcript

  • Catastrophic Health Expenditure Wim Van Damme Institute of Tropical Medicine, Antwerp ICHD, March 2004
  • Overview
    • What is Catastrophic Health Expenditure?
    • What is the evidence?
    • What are the determinants?
    • What can be done?
  • What is Catastrophic Health Expenditure?
    • Health care costs
    •  can cause a “shock” in the household economy
    •  sometimes: “catastrophic”
      • Leading to poverty; or
      • Pushing households deeper in poverty
  • What is the evidence?
    • Anecdotal
    • Household expenditure surveys (WHO  Lancet 2003)
      • Definition: “ Households that used
      • >40% of household’s capacity to pay”
      • Some countries: very high
      • Many countries: very low
      • African countries: “low”? but few data
  • Highest
    • Countries in transition
    • Latin America
    • Lebanon
    ?? China 5.02% Cambodia 5.17% Lebanon 5.77% Argentina 6.26% Colombia 7.15% Azerbaijan 10.27% Brazil 10.45% Vietnam
  • Comparison with rich countries 0.55% USA 0.04% UK 0.03% Germany 0.02% Belgium 0.01% France
  • Comparison with other developing countries 1.30% Ghana 0.03% South-Africa 0.55% Senegal 0.80% Thailand 1.26% Indonesia 2.29% Zambia
  • Determinants
    • Proportion of health expenditure “out-of-pocket”
    • Attractive for-profit health system & weak non-for-profit health system
    • Weakness of safety nets (formal or informal)
    • (Alternative = forego treatment)
  • Catastrophic health expenditure related to out-of-pocket expenditure
  •  
  • Mechanism
    • To cover health care costs households use:
      • Cash
      • Assets
      • Gifts
      • Purchase care on credit
      • Borrow cash (hard loans or soft loans)
      •  interest payments
      • at a time that income often decreases (due to illness of income earner)
  • As a result
      • Reduced consumption of e.g. food
      • Reduced expenditure for schooling of children…
      • Loss of productive assets (incl. land!!, if “land market”)
        • … . i atrogenic poverty
  • Not well documented:
    • Type of expenditure?
      • Pharmaceuticals!!
      • Private clinics or hospitals
      • Fees in public facilities?
    • Type of health problem?
      • Anything needing hospitalisation?
      • Chronic diseases: TB – AIDS …
    • Was care needed???
  • “ Health sector”
    • Individual costs
      • Highly unpredictable (risk)
      • Highly skewed to
        • Unlucky – unhealthy
        • Very young & very old
    • Asymmetry of information
    • Market failure
  • To reduce catastrophic expenditure:
    • Reduce out-of-pocket expenditure, especially for
      • Potentially catastrophic expenditures
      • For poor
    • How?
      • More subsidies: government (tax) – donors
      • Pooling of resources: insurance (tax)
      • Rationalise offer of care; improve health seeking behaviour, …
      • Do not ignore hospitals!! / private sector!!!
    • Context-specific strategy
  • Examples, depends on context
    • Good service for free & accessible
    • Good service cheap & accessible
      • Who will pay? Donor? Or government?
    • Development of social health insurance / community-based health insurance (?)
    • Safety net (e.g. health equity fund)
      • Who will pay? Donor? Or government?
    • Combination of supply-side & demand-side interventions…
  • Short and long routes of accountability
  • Use of donor money…