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Providing protection against the financial risk of high out-of-pocket health spending is one of the main goals of the Philippines' health strategy. Yet, as this paper shows using eight household surveys, health spending increased by 150 percent (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has trebled since 2000, from 2.5 to 7.7 percent. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate. In light of these findings, recent policies to enhance financial risk protection-such as the expansion of government-subsidized health insurance for the poor, a deepening of the benefit package, and provider payment reform aimed at cost-containment-are to be applauded. Between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, possible quick wins could include issuing health insurance cards for the poor to increase awareness of coverage and introducing a fixed copayment for non-poor members. Over the medium term, complementary investments in supply-side readiness are essential. Finally, an in-depth analysis of the pharmaceutical sector would help to shed light on why medicines continue to place such a large financial burden on households.

Health Economics & Finance --- Health Economics And Finance --- Health Equity And Access --- Health Insurance --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Law and Development --- Out-Of-Pocket --- Poverty Measurement And Analysis --- Poverty Reduction --- Rural Poverty Reduction

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This paper uses a common household survey instrument and a common set of imputation assumptions to estimate the pro-poorness of government health expenditure across 69 countries at all levels of income. On average, government health expenditure emerges as significantly pro-rich, but there is heterogeneity across countries: in the majority, government health expenditure is neither pro-rich nor pro-poor, while in a small minority it is pro-rich, and in an even smaller minority it is pro-poor. Government health expenditure on contracted private facilities emerges as significantly pro-rich for all types of care, and in almost all Asian countries government health expenditure overall is significantly pro-rich. The pro-poorness of government health expenditure at the country level is significantly and positively correlated with gross domestic product per capita and government health expenditure per capita, significantly and negatively correlated with the share of government facility revenues coming from user fees, and significantly and positively correlated with six measures of the quality of a country's governance; it is not, however, correlated with the size of the private sector nor with the degree to which the private sector delivers care disproportionately to the better-off. Because poorly-governed countries are underrepresented in the sample, government health expenditure is likely to be even more pro-rich in the world as a whole than it is in the countries in this study.

Concentration Index --- E-Business --- Economic Theory & Research --- Government Facility Revenues --- Government Health Expenditure --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Income Redistribution --- Information and Communication Technologies --- Information Security and Privacy --- Macroeconomics and Economic Growth --- Private Sector Development --- Subsidy Incidence

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The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a 'mashup' index that captures both aspects of UHC: that everyone-irrespective of their ability-to-pay-gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35-57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data-by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.

Communities & human settlements --- Equity --- Financial protection --- Health economics & finance --- Health law --- Health monitoring & evaluation --- Health systems development & reform --- Health, nutrition and population --- Housing & human habitats --- Law and development --- Service coverage --- Universal health coverage