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Social Protection

Building social protection floors and comprehensive social security systems

Access to health services & health-related poverty

Updated by Xenia Scheil-Adlung on 11.06.2015

Extending social protection coverage in health means creating effective access to health services that meet the needs of the people. Effective access means that services are available, affordable and that people are protected from loss of income when illness occurs.

Basic protection is necessary for all people, regardless of individual income level or country development status. Indicators such as poverty rate and the extent of the informal economy contribute to a country’s vulnerability. Additionally, certain populations – the poor, women, elderly, disabled – are particularly vulnerable to catastrophic loss of income due to their health needs and needs dedicated protection.


Too often, when people get sick and can’t afford to pay doctor bills, they either don’t seek treatment and get sicker and sicker until they can no longer work, thus losing their income; or, sell property or borrow beyond their means to pay for care, creating a cycle of debt that they can’t overcome.


Affordability is not the only barrier for access to health services; in addition, geographical, cultural, informational, organizational, and other barriers may come into play. However, cost is the main reason why sick people do not seek care, and the focus of the ILO strategy towards universal access to health care is therefore on overcoming financial barriers to access through social health protection coverage.

Financial protection addresses health-related poverty by reducing out-of-pocket payments (OOP), covering catastrophic health expenditure (> 40 per cent of a households' income net of subsistence), and - ideally – providing compensation for productivity loss due to illness.

Out-of-pocket payments place a considerable financial burden on households at a time of reduced income and crisis. OOPs constitute the most inequitable source of health financing, yet they are the largest source of financing for health, especially in poor countries.

Vulnerability of countries and sources of funds

Source: ILO (2011), World Social Security Report, p. 38.