Correlates of out-of-pocket spending on health in Nepal: implications for policy.

Background: A key objective of universal health coverage is to address inequities in the financial implications of health care. This paper examines the level and trend in out-of-pocket spending (OOPS) on health, and the consequent burden on Nepalese households. Methods: Using data from the Nepal Living Standard Survey for 1995–1996 and 2010–2011, the paper looks at the inequity of this burden and its changes over time; across ecological zones or belts, development regions, places of residence, or consumption expenditure quintiles; and according to the gender of the head of the household. Results: The average per capita OOPS on health in Nepal increased sevenfold in nominal terms between 1995–1996 and 2010–2011. The share of OOPS in household consumption expenditure also increased during the same period, primarily as a result of higher health spending by poorer households. Thirteen per cent of all households were found to incur catastrophic health expenses in 2010– 2011. This proportion of households incurring such expenditure rose between the two time periods most sharply in the Terai belt, eastern region and poorest quintile. Conclusion: The health-financing system in Nepal has become regressive over the years, as the share of the bottom two quintiles in the total number of households facing catastrophic burden increased by 14% between the two periods.

Economic burden of malaria in India: The need for effective spending.

About 95% of India’s population resides in malaria-endemic areas and, according to government sources, 80% of malaria reported in the country is confined to populations residing in tribal, hilly, difficult and inaccessible areas. Using a nationally representative sample, this study has estimated the economic burden of malaria in India by applying the cost-of-illness approach, using the information on cost of treatment, days lost and earnings foregone, from the National Sample Survey data. A sensitivity analysis was carried out, by presenting two alternative scenarios of deaths. The results indicate that the total economic burden from malaria in India could be around US$ 1940 million. The major burden comes from lost earnings (75%), while 24% comes from treatment costs. Since mortality is low, this is not a major source of economic burden of malaria. An analysis of the trend and patterns in public expenditure by the National Vector Borne Disease Control Programme shows a declining focus of the central government on vector-borne diseases. Also, allocation of financial resources among states does not reflect the burden of malaria, the major vector-borne disease in the country.