Over 78 million more Asians than previously thought are living in extreme poverty because they have had to pay for health care, according to an Article in this week's issue of The Lancet.
Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. In this study, Eddy van Doorslaer (Erasmus University Medical Centre, Rotterdam, Netherlands) and colleagues in the EQUITAP Study Group reassessed measures of poverty in 11 low-to-middle income countries (Bangladesh, China, India, Indonesia, Kyrgyz Republic, Malaysia, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam) that account for 79% of the population in Asia--and 48% of the world's population.
After subtracting payments for health care from total household resources, they looked at the number of individuals with less than the internationally accepted threshold of absolute poverty – US$1 per head per day. They found that the overall prevalence of poverty in the countries studied was 14% higher than conventional estimates. This means 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. The investigators found that the burden of health care payments was highest in Vietnam, Bangladesh, India, and China and lowest in Malaysia, Thailand, and Indonesia. The authors state that policies such as limitation of user charges for public-sector health care and the implementation of effective exemption schemes for the poor can help to mitigate impoverishment through health care payments.
Professor van Doorslaer states: "Out-of-pocket payments for health care exacerbate the prevalence and depth of poverty in Asia…Policies to reduce the number of Asians living on less than $1 per day need to include measures to reduce such payments."
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Contact: Dr Eddy van Doorslaer, Department of Health Policy and Management, Erasmus Medical Centre, and Department of Applied Economics, Erasmus University, PO Box 1738, 3000 DR Rotterdam, Netherlands. T) +31 10 4635285 (press office) email@example.com
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