Using household surveys to investigate the incidence, and impoverishing impact, of out of pocket pay

1
Using household surveys to investigate the
incidence, and impoverishing impact, of out of
pocket payments for medicines
Jane Falkingham School of Social
Science University of Southampton Toward a
Medicines Transparency Alliance (MeTA) April 17,
2007
2
Exploiting existing sources of data on out of
pocket payments for medicines

• WHO World Health Surveys
• World Bank Living Standards Measurement Surveys
• National Household Expenditure Surveys (often
  collected to calculate weights for CPI)
• Other national and local studies

3
The advantage of household based surveys

• Can relate data on health care expenditures to
  other individual and household characteristics
• allows us to look at profile of consumers in
  terms of age, gender, household socio-economic
  status, region etc
• can construct complex measures of the incidence
  of expenditures e.g. level of catastrophic
  payments and the impoverishing impact of
  out-of-pocket payments
• complement HAI affordability measures as can
  take into account differences in the prices
  people actually face and differences in the
  resources people have available to them

4
The advantage of household based surveys

• Household surveys also allow us to collect data
  from non-users
• Facilitates analysis of who is NOT using
  services/ purchasing drugs
• Useful in identifying barriers to access

5
Selected key findings from the literature

• Spending on drugs constitute the largest share of
  OOP for health
• Drugs and medical supplies make up 79 of total
  costs in Ghana medicines costs represent 64 of
  the total in Benin

6
Majority of spending on hospitalisation is on
drugs
Source India National Sample Survey 2004
7
Selected key findings from the literature

• Poorest households spend a higher proportion of
  their monthly household budget on outpatient care
  compared with the wealthy

8
Source Jordan Healthcare Utilization and
Expenditure Survey 2000
9
Selected key findings from the literature

• Even modest out-of-pocket expenditures can caused
  indebtedness and lead to poverty

10
Going into debt is a common result of a hospital
inpatient stay
Source India National Sample Survey 2004
11
Selected key findings from the literature

• Poor people may chose to go without treatment

12
The advantage of a household survey rather than a
facility based survey is that a household survey
captures both users and non-users of health care.
Source Kyrgyz Household Health Financing Survey
2001 and 2004
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Expense remains a major barrier to access
Source Kyrgyz Household Health Financing Survey
2004
14
Surveys allow calculation of sophisticated
incidence measures
Incidence and intensity of catastrophic health
payment in Kyrgyzstan 2004, with per capita non
food consumption as the welfare indicator
NB A positive value of C indicates a greater
tendency for the better-off to exceed the payment
threshold, while a negative value indicates that
the worse-off are more likely to exceed the
threshold.
Source Kyrgyz Household Health Financing Survey
2004