Who Pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North Africa
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World Bank, Washington, DC
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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.
Palabras clave
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