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Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan

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  • Falkingham, Jane
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    Abstract

    Most countries of the Former Soviet Union (FSU) have either initiated or are contemplating reform of the health sector. With negative real income growth and falling government revenues, a key concern of many governments is to secure additional finance through non-budgetary sources such as hypothecated payroll taxes, voluntary insurance, and increased private finance through patient cost-sharing. However, before such reforms can be considered, information is needed both on the current levels and distribution of household expenditures on health care, and the extent to which increased charges may affect access to health services, especially amongst the poor. This paper uses the Tajikistan Livings Standard Survey to investigate the level and distribution of out-of-pocket payments for health care in Tajikistan and to examine the extent to which such payments act as barriers to health-care access. The data show that there are significant differences in health-care utilisation rates across socio-economic groups and that these differences are related to ability to pay. Official and informal payments are acting both to deter people from seeking medical assistance and once advice has been sought, from receiving the most appropriate treatment. Despite informal exemptions, out-of-pocket payments for health care are exacting a high toll on household welfare with households being forced to sell assets or go into debt to meet the costs of care. Urgent action is needed to ensure equity in access to health care.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 58 (2004)
    Issue (Month): 2 (January)
    Pages: 247-258

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    Handle: RePEc:eee:socmed:v:58:y:2004:i:2:p:247-258

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    Keywords: Health financing Informal payments Poverty Tajikistan;

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    Cited by:
    1. Waśniewski, Krzysztof, 2012. "Comparative, dynamic efficiency of national healthcare systems," MPRA Paper 38029, University Library of Munich, Germany.
    2. World Bank, 2008. "Tajikistan - Second Programmatic Public Expenditure Review : Volume 4. Public Expenditure Ttracking Survey (PETS), Health Sector," World Bank Other Operational Studies 6135, The World Bank.
    3. Ilhom Abdulloev & Ira N. Gang & John Landon-Lane, 2011. "Migration as a Substitute for Informal Activities: Evidence from Tajikistan," CReAM Discussion Paper Series 1124, Centre for Research and Analysis of Migration (CReAM), Department of Economics, University College London.
    4. Brück, Tilman & Esenaliev, Damir & Kroeger, Antje & Kudebayeva, Alma & Mirkasimov, Bakhrom & Steiner, Susan, 2012. "Household Survey Data for Research on Well-Being and Behavior in Central Asia," IZA Discussion Papers 7055, Institute for the Study of Labor (IZA).
    5. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
    6. Cherecheş, Răzvan M. & Ungureanu, Marius I. & Sandu, Petru & Rus, Ioana A., 2013. "Defining informal payments in healthcare: A systematic review," Health Policy, Elsevier, vol. 110(2), pages 105-114.
    7. Syed M. Ahsan & Syed Abdul Hamid & Shubhasish Barua, 2012. "Utilisation of Formal Health Care and Out-of-Pocket Payments in Rural Bangladesh," Working Papers 13, Institute of Microfinance (InM).
    8. Habibov, Nazim N. & Fan, Lida, 2011. "Does prenatal healthcare improve child birthweight outcomes in Azerbaijan? Results of the national Demographic and Health Survey," Economics & Human Biology, Elsevier, vol. 9(1), pages 56-65, January.

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