Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data

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$1 per day need to include measures to reduce such payments. © 2006 Elsevier Ltd. All rights reserved.link_to_subscribed_fulltex

Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data

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$1 per day need to include measures to reduce such payments. © 2006 Elsevier Ltd. All rights reserved.link_to_subscribed_fulltex

Has universal health insurance reduced socioeconomic inequalities in urban and rural health service use in Thailand?

This study analyses urban and rural health service use before and after the introduction of the Universal Coverage Scheme (UCS). Using data from the Thai national health surveys of 2001 and 2005, the study utilises age–sex adjusted concentration indices to measure within-area differences in use of health services among populations distinguished by socioeconomic status. Between 2001 and 2005, the UCS substantially reduced Thailand’s uninsured population (from 42.5% to 7.0% in urban areas and from 24.9% to 2.7% in rural areas). The implementation of the UCS changed patterns of health services use, particularly for rural people and the urban poor, by placing greater emphasis on primary healthcare. Relevant policy recommendations should focus on continued improvement of primary health services, and ensuring adequate and timely referrals to secondary and tertiary health services when the need arises