In much of Asia, households are liable for large out-of-pocket payments when they use health services. As a result, many fail to seek care or get inadequate care, while others seek care but end up in financial difficulty. Expanding insurance is one obvious policy solution, but private and community-based insurance schemes have rarely been successful, and social insurance schemes have struggled with the problem of covering the informal sector and the poor; some countries as a result have resorted to a predominantly tax-financed health system. But demand-side factors are only one part of the problem. The cost of health care itself is often unnecessarily high because of weak supply-side incentives. Limited controls on provider prices and type of care delivered can mean that the insured simply end up with higher-priced care. A first strand of the project examines how, in six Asian countries (Cambodia, China, Indonesia, the Philippines, Thailand, and Vietnam), price and other barriers impede use of health care, and result in inequalities in use. It also looks at how households cope with health shocks, and whether they are able to prevent health expenditures and income losses associated with illness from causing sudden and potentially impoverishing drops in consumption. A second strand evaluates the impact of a variety of programs that aim at promoting health care use (especially among the poor), enhance quality and contain costs, and hence help ensure that households are protected from the financial consequences of health shocks. The project builds on successful previous collaborations, but has several innovative features: a focus on the causes of inequity and lack of financial protection, and the impact of programs on both; a mix of cross-country comparative work and in-depth country-specific work; a mix of academic researchers and policy analysts; and an equal emphasis on dissemination to researchers, policymakers and the international development community.
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