FYI - Paper from this weeks Lancet that may be of interest
LSE Health and Social Care
Effect of payments for health care on poverty estimates in 11 countries in Asia <http://www.thelancet.com/journals/lancet/article/PIIS0140673606695603/abstract>
van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S, Karan A, Ng CW, Pande BR, Racelis R, Tao S, Tin K, Tisayaticom K, Trisnantoro L, Vasavid C, Zhao Y
The Lancet 2006; 368:1357-1364
Background Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care.
Methods We obtained data on payments for health care from nationally representative surveys, and subtracted these payments from total household resources. We then calculated the number of individuals with less than the internationally accepted threshold of absolute poverty (US$1 per head per day) after making health payments. We also assessed the effect of health-care payments on the poverty gap-the amount by which household resources fell short of the $1 poverty line in these countries.
Findings Our estimate of the overall prevalence of absolute poverty in these countries was 14% higher than conventional estimates that do not take account of out-of-pocket payments for health care. We calculated that an additional 2·7% of the population under study (78 million people) ended up with less than $1 per day after they had paid for health care. In Bangladesh, China, India, Nepal, and Vietnam, where more than 60% of health-care costs are paid out-of-pocket by households, our estimates of poverty were much higher than conventional figures, ranging from an additional 1·2% of the population in Vietnam to 3·8% in Bangladesh.
Interpretation Out-of-pocket health payments exacerbate poverty. Policies to reduce the number of Asians living on less than $1 per day need to include measures to reduce such payments.
a. Department of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, the Netherlands
b. University of Macedonia, Thessaloniki, Greece
c. Institute for Health Policy, Colombo, Sri Lanka
d. Nepal Health Economics Association, Kathmandu, Nepal
e. World Health Organization, Geneva, Switzerland
f. Gadjah Mada University, Jogjakarta, Indonesia
g. University of the Philippines, Quezon City, Philippines
h. Jahangirnagar University, Savar, Dhaka, Bangladesh
i. National Statistical Committee, Bishkek city, Kyrgyz Republic
j. Institute for Human Development, New Delhi, India
k. Ministry of Health, Quality and Standards Unit, Putrajaya, Malaysia
l. North China Coal Medical College, Tangshan City, China
m. University of Hong Kong, Hong Kong Special Administrative Region, China
n. International Health Policy Programme, Nonthaburi, Thailand
o. National Health Economics Institute, Beijing City, China