CONTEXT With drug spending rising rapidly for working-aged adults, many employers and health insurance providers have changed benefits packages to encourage use of fewer or less expensive drugs. It is unknown how these initiatives affect drug costs. OBJECTIVE To examine how innovations in benefits packages, such as those that include multitier formularies and mandatory generic substitution, a...

The French government introduced a 'free complementary health insurance plan' in 2000, which covers most of the out-of-pocket payments faced by the poorest 10% of French residents. This plan was designed to help the non-elderly poor to access health care. To assess the impact of the introduction of the plan on its beneficiaries, we use a longitudinal data set to compare, for the same individual...

BACKGROUND Many health systems in Africa are funded primarily through out-of-pocket payments. Out-of-pocket payments prevent people from seeking care, can result to catastrophic health spending and lead to impoverishment. This paper estimates the burden of out-of-pocket payments in Kenya; the incidence and intensity of catastrophic health care expenditure and the effect of health spending on na...

This paper assesses both out-of-pocket payments for healthcare and losses of productivity over six months postpartum among women who gave birth in Matlab, Bangladesh. The hypothesis of the study objective is that obstetric morbidity leads women to seek care at which time out-of-pocket expenditure is incurred. Second, a woman may also take time out from employment or from doing her household cho...

Cross-sectional health expenditure data are used to compare health expenditure aggregates and the contribution of the public and private sectors in a selection of 31 low, middle and high income countries. The comparative data illustrate the diversity of outcomes in terms of total health expenditure and its components even amongst countries with similar GDP per capita. Low and middle income coun...

Payments towards health care, apart from securing access to health services, may also redistribute income. While such redistribution may be intended or unintended, policymakers are generally interested in the degree to which it occurs because of consequences for the distribution of goods and services other than health care. The rationale for being more concerned with the redistributive impact o...

New health technology comes on the market at a rapid pace and - sometimes - at a huge cost. Providing access to new health technology is a serious challenge for many countries with mandatory health insurance. This article analyses access to new health technology in Belgium and the Netherlands, using eight concrete examples as a starting point for comparing the two - neighbouring - countries. Co...

This paper assesses the extent of the financial burden due to out-of-pocket payments for health care incurred by people living with HIV (PLHIV) and the effect of this burden on their financial capacity. Data were collected in a cross-sectional survey of 353 PLHIV from three cities in Indonesia (Jakarta, Jogjakarta and Merauke). Respondents in Jakarta were sampled from one hospital and one non-g...

BACKGROUND As the drive towards universal coverage is gaining momentum globally, the need for assessing levels of financial health protection in countries, particularity the developing world, has increasingly become important. In Swaziland, the level of financial health protection is not clearly understood. OBJECTIVE To assess financial catastrophe and impoverishment from out-of-pocket paymen...

Designing and implementing a health financing policy for universal coverage is relatively simple in principle but complex in practice. This issue of the Bulletin explores how it can be done, drawing lessons from several country experiences. Equity of access to health services of all types is key to universal coverage policy. High levels of out-of-pocket payments, including user fees, are still ...