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Catastrophic payments for health care in Asia


  • Eddy van Doorslaer

    (Erasmus University, The Netherlands)

  • Owen O'Donnell

    (University of Macedonia, Greece)

  • Ravindra P. Rannan-Eliya

    (Institute for Health Policy, Sri Lanka)

  • Aparnaa Somanathan

    (Institute for Health Policy, Sri Lanka)

  • Shiva Raj Adhikari

    (Nepal Health Economics Association, Nepal)

  • Charu C. Garg

    (World Health Organisation, Switzerland)

  • Deni Harbianto

    (Gadjah Mada University, Indonesia)

  • Alejandro N. Herrin

    (University of the Philippines, Philippines)

  • Mohammed Nazmul Huq

    (Jahangirnagar University, Bangladesh)

  • Shamsia Ibragimova

    (National Statistical Committee, Kyrgyz Republic)

  • Anup Karan

    (Institute for Human Development, India)

  • Tae-Jin Lee

    (Hallym University, South Korea)

  • Gabriel M. Leung

    (University of Hong Kong, Hong Kong SAR)

  • Jui-Fen Rachel Lu

    (Chang Gung University, Taiwan)

  • Chiu Wan Ng

    (University of Malaysia, Malaysia)

  • Badri Raj Pande

    (Nepal Health Economics Association, Nepal)

  • Rachel Racelis

    (University of the Philippines, Philippines)

  • Sihai Tao

    (North China Coal Medical College, China)

  • Keith Tin

    (University of Hong Kong, Hong Kong SAR)

  • Kanjana Tisayaticom

    (International Health Policy Program, Thailand)

  • Laksono Trisnantoro

    (Gadjah Mada University, Indonesia)

  • Chitpranee Vasavid

    (International Health Policy Program, Thailand)

  • Yuxin Zhao

    (National Health Economics Institute, China)


Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household living standards, and approximate such payments by those absorbing a large fraction of household resources. Bangladesh, China, India, Nepal and Vietnam rely most heavily on OOP financing and have the highest incidence of catastrophic payments. Sri Lanka, Thailand and Malaysia stand out as low to middle income countries that have constrained both the OOP share of health financing and the catastrophic impact of direct payments. In most low|middle-income countries, the better-off are more likely to spend a large fraction of total household resources on health care. This may reflect the inability of the poorest of the poor to divert resources from other basic needs and possibly the protection of the poor from user charges offered in some countries. But in China, Kyrgyz and Vietnam, where there are no exemptions of the poor from charges, they are as, or even more, likely to incur catastrophic payments. Copyright © 2007 John Wiley & Sons, Ltd.

Suggested Citation

  • Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
  • Handle: RePEc:wly:hlthec:v:16:y:2007:i:11:p:1159-1184 DOI: 10.1002/hec.1209

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    References listed on IDEAS

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