Prices, Access, and Affordability: scoping household out of pocket payments for medicines

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Prices, Access, and Affordability scoping
household out of pocket payments for medicines
Jane Falkingham, Fifii Amoko Johnson, Zoë
Matthews and Saseendran Pallikadavath, Centre
for AIDS Research, School of Social
Science University of Southampton Toward a
Medicines Transparency Alliance (MeTA) Issues for
Consumers and Civil Society March 14, 2007
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Objectives of the study

• To identify existing national, sub-national and
  local datasets unpublished) that could provide
  information about OOP on pharmaceutical drugs
• To make a preliminary assessment of OOP for drugs
• To review strengths and weaknesses of existing
  measures of affordability of pharmaceutical drugs
  at individual, household and population level

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Methodology

• DATA COLLECTION
• Electronic search of literature
• Consultation (email, phone)
• ANALYSIS AND OUTPUTS
• List of data sets
• Summary of key findings from literature search
• Proportion of HH income spent on pharmaceutical
  drugs
• Proportion of HH income spent on health care
• Proportion of medical expenditure on
  pharmaceutical drugs
• Discussion on affordability (including poverty
  linkages) of pharmaceutical drugs

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Key findings (to date ..)

• BASED on
• Surveys (other than WHS) for 59 countries
• 33 published papers (with more to come)

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Key findings (to date ..)

• Insured (Community Insurance) people spend less
  compared to non-insured people
• Proportion of HH making Catastrophic OOP higher
  in transition and certain Latin American
  countries
• Poorest households spend a higher proportion of
  their monthly household budget on outpatient care
  compared with the wealthy
• Even modest OOP health expenditure can caused
  indebtedness and lead to poverty
• Poor people may chose to go without treatment

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Key findings (to date ..)

• Spending on drugs constitute the largest share of
  OOP for health
• Drugs and medical supplies make up 79 of total
  costs in Ghana medicines costs represent 64 of
  the total in Benin
• Irrational prescribing is high higher among
  private doctors compared to public doctors
• Private health care providers have increased
  during 1990s
• In Tanzania, families who took their children to
  private clinics had to pay 30 times as much as at
  government clinics

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Case Study I India

• National Sample Survey (NSS 60th round)
• Morbidity and Health care survey January to June
  2004
• (also in 1987 and 1996)
• Expenditure of the HH for health care services
  both hospitalisation and primary care inc drugs
• All India study (Except some areas in JK and
  Nagaland, AN Islands)
• Rural sample (47,302 HH) Urban sample (26,566
  HH)

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Rising use of private inpatient care
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But differences across states
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Average expenditure on hospitalisation in last
year is non trivial
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Majority of spending on hospitalisation is on
drugs
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As is spending on outpatient health care(total
spending in last 15 days averages 3.50)
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Going into debt is a common result of a hospital
inpatient stay
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And a significant proportion have to borrow even
to pay relatively modest outpatient costs
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Case study II Jordan

• Jordan Healthcare Utilization and Expenditure
  Survey (JHUES) 2000
• 8,306 households 49,543 individuals
• average annual per capita out-of-pocket
  expenditure of JD 32.77, of which three-quarters
  comprises expenditures for drugs and half is
  spent on routine medication for chronic illness

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Case Study III Ghana

• Ghana Living Standards Survey (GLSS) 1991/2
• c.4,500 households 20,368 individuals
• 22 reported illness/injury in 2 weeks preceding
  interview
• One-half of those who reported an illness or
  injury consulted a health practitioner, dentist
  or traditional healer or visited a health centre
  in the previous two weeks.
• 82 of those who sought medical consultation in
  the two weeks purchased medicines and medical
  supplies.
• The average amount paid for medicines and medical
  supplies was about 1,900.
• One-half of those who bought medicines and
  medical supplies paid no more than 1,000.
• Those who had consulted a doctor or traditional
  healer spent more on medicines and medical
  supplies (on average, 2,500 and 1,800
  respectively) than those who had consulted a
  nurse, midwife or medical assistant (1,100) or
  pharmacist (1,000).
• Medicines and medical supplies purchased for
  females tended to be rather more expensive than
  those bought for males.

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Case Study III Ghana

• Ghana Living Standards Survey (GLSS) 1998/9
• c.6,000 households 25,694 individuals
• 26 reported illness/injury in 2 weeks preceding
  interview (UP)
• 44 of those who reported an illness or injury
  consulted a health practitioner, dentist or
  traditional healer or visited a health centre in
  the previous two weeks (DOWN)
• Just 1/3 of those who sought medical consultation
  in the two weeks purchased medicines and medical
  supplies (DRAMATICALLY DOWN)
• Only 3 percent of this group received their
  medicines and supplies free of charge, half of
  them spent about 2,500, and another quarter paid
  up to 4,500.
• In a few cases (less than 1) there were
  responses of more than 200,000 expenditure on
  medicines and supplies.

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Next steps

• Further analytic work
• Patterns of health care seeking and how this
  varies across different groups
• Levels and correlates of catastrophic payments
• Impoverishing impact
• Comparison where possible with WHS
• Further bibliographic review
• Potential new areas
• Links between OOP and MDGs
• OOP for reproductive health care