Access to health protection: Affordability
Reducing out-of-pocket payment is of utmost importance when trying to achieve more equitable health outcomes
Affordability of health care is strongly related to the extent of out-of-pocket payments (OOP) in a given country. In nearly all countries throughout the world, OOP are involved in seeking health care. High OOP affect the accessibility of care by making it less affordable, deterring individuals from seeking care. In addition, OOP may push households into poverty or deepen existing poverty. Catastrophic health expenditure occurs whenever a household's total OOP exceed 40% of the household's income net of subsistence.
OOP are frequent where legal health coverage is absent. It is also common in countries that have not fully implemented and enforced existing legislation. Additionally, OOP occur in the absence of well-designed benefit packages that are not linking eligibility and affordability. This might happen if the scope of the benefits provided is too limited or co-payments, user fees and others costs are high.
In countries with high OOP, legal health coverage remains meaningless given the lack of effective access. An overview of the extent of legal health coverage and OOP in selected African countries is provided below. It shows that in some countries with relatively high legal health coverage rates, such as Mauritius and Egypt, OOP still exceeds 50 per cent of total health expenditure.
Legal health coverage and out-of-pocket payments in selected
African countries, 2011 (percentages)
Among the most important causes of OOP are limitations of benefit packages and low quality of services provided. As a result, services will be sought elsewhere and paid directly out-of-pocket. The cost-sharing schedule (cost-sharing rates, cost-sharing ceilings or benefit ceilings) equally affects the affordability of health care.
Benefit packages are sometimes too limited and even the most basic care involves some kind of OOP. In Kenya, for example, nearly 100 per cent of women had to pay fees for maternal care amounting to more than US$18; and in Burkina Faso, 92.5 per cent of women reported paying fees.
Pharmaceutical drugs, i.e. medicines represent one of the most significant components of health-related OOP. They account for 26 to 63 per cent of total OOP and are often excluded from benefit packages. The catastrophic impact of OOP for drugs on households can be expressed in terms of work needed to generate sufficient income to afford them. Taking this into account, the impact on someone living close to or in poverty is devastating.