Description: Who Pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North Africa

Who Pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North Africa

Ensuring affordable, effective health care and financial protection against the adverse effects of household out-of-pocket (OOP) health expenditures represents an important policy objective in most countries, yet relatively little evidence exists r...

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Bibliographic Details
Main Authors:	Elgazzar, Heba, Raad, Firas, Arfa, Chokri, Mataria, Awad, Salti, Nisreen, Chaaban, Jad, Salehi-Isfahani, Djavad, Fesharaki, Sanaz, Majbouri, Mehdi
Language:	English en_US
Published:	World Bank, Washington, DC 2013
Subjects:	ABILITY TO PAY ACCESS TO HEALTH CARE ACCESS TO HEALTH SERVICES ANTENATAL CARE BASIC HEALTH CARE BASIC HEALTH SERVICES BASIC SERVICES CATASTROPHIC EXPENDITURES CATASTROPHIC HEALTH SPENDING CHILD HEALTH CHILD HEALTH SERVICES CLINICS COSTS OF CARE COSTS OF HEALTH CARE DECISION MAKING DELIVERY OF HEALTH CARE DEMAND FOR HEALTH DEMAND FOR HEALTH CARE DENTAL CARE DETERMINANTS OF HEALTH DIABETES DIAGNOSTIC SERVICES DISADVANTAGED COMMUNITIES DRUGS ECONOMIC GROWTH ELIGIBLE BENEFICIARIES EMPOWERMENT EXPOSURE FAMILY PLANNING FEE-FOR-SERVICE FEE-FOR-SERVICE BASIS FINANCE OF HEALTH CARE FINANCIAL BARRIERS FINANCIAL CONSEQUENCES FINANCIAL PROTECTION FINANCIAL RISK HEALTH CARE HEALTH CARE ACCESS HEALTH CARE COSTS HEALTH CARE COVERAGE HEALTH CARE EXPENDITURE HEALTH CARE EXPENDITURES HEALTH CARE FACILITIES HEALTH CARE FINANCE HEALTH CARE FINANCING HEALTH CARE NEEDS HEALTH CARE PERSONNEL HEALTH CARE PROFESSIONALS HEALTH CARE PROVIDERS HEALTH CARE RESOURCES HEALTH CARE SERVICES HEALTH CARE SPENDING HEALTH CARE SYSTEM HEALTH CARE USE HEALTH CONDITIONS HEALTH ECONOMICS HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FINANCING HEALTH FINANCING SCHEME HEALTH INDICATORS HEALTH INSURANCE HEALTH INSURANCE COVERAGE HEALTH INSURANCE SCHEME HEALTH INTERVENTIONS HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH POLICY HEALTH PROJECT HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICE USE HEALTH SERVICE UTILIZATION HEALTH SERVICES HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTHCARE HOSPITAL CARE HOSPITALS HOUSEHOLD EXPENDITURE HR HUMAN DEVELOPMENT ILLNESS IMMUNIZATION INCOME INCOME COUNTRIES INCOME GROUPS INCOME HOUSEHOLDS INEQUITY IN HEALTH INFANT MORTALITY INFANT MORTALITY RATE INFANTS INFORMAL SECTOR INFORMATION SYSTEMS INPATIENT CARE INPATIENT HOSPITAL INPATIENT HOSPITAL CARE INSURANCE PLANS INSURANCE PREMIUMS INTERNATIONAL COMPARISONS INTERVENTION LABOR MARKETS LIVING STANDARDS LOW INCOME LOW-INCOME COUNTRIES MALNUTRITION MEDICAL ASSOCIATION MEDICAL COSTS MEDICATION MORTALITY NATIONAL HEALTH NATIONAL HEALTH EXPENDITURES NATIONAL HEALTH INSURANCE NATIONAL HEALTH INSURANCE FUND NATIONAL HEALTH SPENDING NUTRITION OUTPATIENT SERVICES PATIENTS PAYMENTS FOR HEALTH CARE PERFORMANCE INDICATORS PHARMACEUTICAL EXPENDITURES PHARMACEUTICAL SERVICES PHYSICIAN PHYSICIANS POCKET PAYMENTS POCKET PAYMENTS BY HOUSEHOLDS POCKET PAYMENTS FOR HEALTH CARE POLICY RESEARCH POVERTY REDUCTION PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIVATE CLINICS PRIVATE HEALTH CARE SERVICES PRIVATE HEALTH INSURANCE PRIVATE HEALTH SERVICES PRIVATE INSURANCE PRIVATE SECTOR PRIVATE SPENDING PROTECTION MECHANISMS PROTECTIONS PROVIDER INCENTIVES PROVISION OF SERVICES PUBLIC COVERAGE PUBLIC EXPENDITURE PUBLIC HEALTH PUBLIC HEALTH INSURANCE PUBLIC HEALTH INSURANCE SCHEMES PUBLIC INSURANCE PUBLIC INSURANCE SCHEMES PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SECTORS QUALITY OF CARE QUALITY OF HEALTH QUALITY OF HEALTH CARE REHABILITATION REPRODUCTIVE HEALTH RURAL AREAS RURAL HOUSEHOLDS RURAL REGIONS SAFETY NETS SOCIAL EXCLUSION SOCIAL HEALTH INSURANCE SOCIAL HEALTH INSURANCE SCHEMES SOCIAL SECURITY SOCIAL SECURITY SCHEMES SOCIAL WELFARE SUSTAINABILITY USE OF HEALTH CARE SERVICES VACCINATION VISITS WORKERS
Online Access:	http://documents.worldbank.org/curated/en/2010/11/13179390/pays-out-of-pocket-health-spending-equity-implications-middle-east-north-africa http://hdl.handle.net/10986/13606

Description
Summary:	Ensuring affordable, effective health care and financial protection against the adverse effects of household out-of-pocket (OOP) health expenditures represents an important policy objective in most countries, yet relatively little evidence exists regarding patterns and implications of household health expenditures in the Middle East and North Africa (MENA) region. This paper examines the scope of out-of-pocket expenditures and their implications on living standards and policy reforms in six MENA countries including Yemen, the West Bank and Gaza, Egypt, Iran, Tunisia, and Lebanon. Results show that OOP payments represent a relatively high share of total national health care financing at 49 percent on average in the MENA region as of 2006. Households pay an average of 6 percent of their total household expenditure on health. Most of this OOP is spent on medications, doctor visits and diagnostic services. Lower-income and rural households generally face greater financial risk; yet this is reversed where private health services are utilized and paid for more frequently by higher-income groups. 7 to 13 percent of households face particularly high OOP payments, or catastrophic expenditures equal to at least 10 percent of household spending. Poverty rates tend to increase by up to 20 percent after health care spending is accounted for. Results are discussed in light of ongoing policy efforts to strengthen social protection for health care.

Who Pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North Africa

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