Behind the estimates of out-of-pocket spending on health in the former Soviet Union

The countries of the former Soviet Union rely heavily on out-of-pocket payments for health care financing. However, out-of-pocket spending statistics are difficult to compare due to different data collection methodologies. Data are collected either through demand side data collection, via household surveys, or supply side data collection, via health clinics, pharmacies, and other suppliers’ data. This technical report is targeted at producers of out-of-pocket spending data, users of the WHO Global Health Expenditure Database and related publications as well as policy-makers, who wish to improve financial protection, on how to improve the relevant data through introduction of international standards of reporting such as the national health accounts. An analysis of former Soviet Union countries reveals that, all else being constant, countries that use national health accounts report 12% higher out-of-pocket spending. This is because national health accounts promotes the usage of detailed questions in surveys on household health care expenditures. Countries that rely solely on supply side information report 15% percent less out-of-pocket spending than countries with similar economic development and health priority status. The analysis strongly supports the view that national health accounts-based reporting usually based on specialized surveys increases the accuracy of out-of-pocket payments for health care.

Health inequality and deprivation.

This paper looks at health inequality and deprivation, with a particular focus on developing countries. It is specifically concerned with relationships between health and income, especially the extent to which inequality and deprivation in the former is driven by changes in the latter. The paper reports increasing disparity in child mortality among country groups since the mid-1970s. It also reports decreased inequality in life expectancy among countries from the early 1960s until the late 1980s and increased inequality thereafter. Similar patterns in life expectancy deprivation are reported. The paper finds that this is partly due to a changing behavioural relationship between life expectancy and income per capita among countries with low achievement in the former variable. The paper also introduces and provides an overview of the papers that follow in this Supplement.