The push for universal health coverage must continue
In recent years, many developing countries have introduced new health coverage schemes to benefit the uninsured. Weak health infrastructures, a lack of human resources, and tight budget constraints, however, raise questions about the effectiveness of the new schemes. Moreover, in light of the virtual absence of disability income insurance in the developing world, substantial economic illness risks may remain even when effective health coverage is achieved. The EU-funded HEALTHEVENT (Financial protection against health risks - Evidence from an emerging country with universal coverage and methodological considerations) conducted research into both these issues. How exposed are households in middle income countries to illness-related income loss? How do they cope with the financial burdens arising if an earner falls ill and if health coverage gaps lead to high out-of-pocket medical expenses? And how much access to quality healthcare and protection from catastrophic out-of-pocket spending can be new health coverage schemes provide against the backdrop of often overstretched and underfunded healthcare systems? The research was conducted through four studies. The first looked at economic vulnerability to illness in Thailand, focusing on those eligible for the country's universal coverage scheme. It found that severe illness striking healthy workers reduces employment by 18 % and household income by a third. HEALTHEVENT noted that severe illness may lead to reductions non-medical expenditure by up to 13 %. Turning to India, the second study looked at rural Indian households with limited health coverage and no insurance against illness-related earnings loss. It researched the different ways that households respond to illness, noting that – at least in the short run – informal insurance mechanisms protect households from additional adverse effects if an earner suffers a debilitating illness. The third and fourth studies investigated economic vulnerability to illness in Peru. Peruvian informal sector households lose up to 18 % in income and increase out-of-pocket medical spending by over 70 % within a year of serious illness or injury. However, the project also found that a newly introduced health coverage scheme for the poor has positive effects on providing ambulatory care and medication, and removes financial access barriers to healthcare. Overall, the findings inform policymakers, academics, and healthcare authorities that extending health coverage in low- and middle-income countries can reduce financial access barriers to healthcare, but does not eliminate financial risk from out-of-pocket medical expenditures. The research also reveals that households achieve a degree of protection from financial illness risk through informal coping mechanisms, at least in the short run. The effectiveness and sustainability of informal coping is, however, questionable in light of aging populations and a growing burden of chronic disease in the development, both of which raise the need for complex, costly care. The findings should therefore not discourage further expansion of formal social protection in the developing world.
Keywords
Health coverage, medical spending, HEALTHEVENT, universal coverage, disability income insurance, income loss, developing countries
