4 Addressing the Global Health Crisis: Universal Health Protection Policies
2.2. The impoverishment due to high costs of health care
Taking up health care often involves private OOP, such as user fees and co- payments by those entitled to benefits, entire costs of treatments by those lacking coverage
and opportunity costs related to transport to health facilities. Such expenditure is frequently significant and might lead to impoverishment or deepened poverty for those who are poor
already. In the worst case, people are totally excluded from access to any needed health care because they do not have the means to pay for it. Thus, OOP might constitute an
important barrier to access health care even if most in need.
Despite these negative implications, OOP are observed in nearly all countries throughout the world: More than 40 per cent of the global burden of health expenditure is
borne by private households. The regressive character of OOP stands in stark contrast to the key principles of solidarity in financing and the idea of sharing risk across different
socio-economic groups.
OOP are particularly frequent where legal health coverage is absent. This is particularly the case in low-income countries. In fact, we find a positive correlation
between poverty rates and shares of OOP in total health expenditure: the extent of impoverishing OOP in a country increases with the level of the population living below the
poverty line. In countries where less than 2 per cent of the population are living on US2 day, about 20 per cent of total health expenditure derives from OOP; in countries where
more than 50 per cent of the population are living on US2 a day, it amounts to as much as around 50 per cent. Thus it is the poorest and most in need, who suffer most from OOP and
related inequities figure 4.
Figure 4: Share of out-of-pocket payments in total health expenditure, by proportion of the population
living on less than 2 USD a day PPP, 2011 percentages
Note: Weighted by total population. Sources: ILO calculations based on WHO data; poverty data: World Bank, ADB and CEPAL data.
Link: http:www.social-protection.orggimigessRessourceDownload.action?ressource.ressourceId=42859
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