Читать книгу The Political Economy of the BRICS Countries - Группа авторов - Страница 78

Next, we look at the second dimension of path to UHC — financial protection. The share of out-of-pocket expenditure in total health expenditure of a country is a commonly used indicator of the need for financial protection — especially of the poor — from the costs of health care.

Figure 1 presents a 15-year trend in this indicator for BRICS. India has the highest share of OOP in total health expenditure, while South Africa has the lowest. In fact, India is the only country in this group to have more than half of its health expenditure financed out-of-pocket. All the countries except Russia show a decline in the share of OOP over the years, although the rate of decline varies. The most significant decline has happened in the case of China where the share of OOP declined by 27 percentage points in 15 years, the same being only 6 percentage points for India. Russia presents a peculiar case where the share of OOP in total health expenditure has increased by 16 percentage points in the last 15 years.

Figure 1:Out-of-pocket expenditure (OOPS) as % of total health expenditure (THE).

Source: Global Health Expenditure Database, World Health Organization.

The immediate fallout of a high-OOP share in total health spending is the risk of catastrophic expenditures and impoverishment. The only indicator for which data was available to measure catastrophic expenditure was for surgical care (Figure 2). India is the most vulnerable by this measure of financial vulnerability from OOP health care expenses. Needless to state that data for the entire spectrum of health services (not only surgical and anesthetic) would have given a more nuanced picture, but would probably not have altered India’s ranking.

Figure 2:Risk of catastrophic expenditure for surgical care (% of people at risk), 2014.

Note: Catastrophic expenditure is defined as direct out-of-pocket payments for surgical and anesthesia care exceeding 10% of total income.

Source: World Development Indicators, World Bank.

Figure 3:Health expenditure per capita (current US dollar).

Source: World Development Indicators, World Bank.