Embargoed Until:
July 16, 2007
12:01 a.m. Eastern Time



Christopher Fleming

Paying For Health Care Out Of Pocket Impoverishes 150 Million Worldwide; Prepayment Systems Can Help

First Global Health Issue Of Health Affairs Also Examines AIDS Vaccine, Global Health Aid Distribution, And More; Separate Web Article Surveys Health Status Perceptions


Bethesda, MD -- At least 150 million people worldwide suffer financial catastrophe each year and 100 million are pushed under the poverty level simply because they need to pay for health services, according to new World Health Organization (WHO) research published today in the July-August issue of the journal Health Affairs. The new Health Affairs issue, a thematic volume on global health that focuses particularly on financing questions, is published with the support of a five-year grant from the Bill and Melinda Gates Foundation.

The WHO study encompasses 89 countries covering 89 percent of the world’s population, making possible the first global estimates of the extent of catastrophic spending and associated impoverishment. Countries that fund their health care systems using some form of prepayment, such as taxes or insurance, were less likely than countries that fund their health care systems through out-of-pocket payments to have a population that suffered financial catastrophe, WHO researchers found. When prepayment accounts for more than 80 percent of all health payments, the incidence of financial catastrophe is less than 1 percent. http://content.healthaffairs.org/cgi/content/abstract/26/4/636

The study, which builds upon previous work that examined such spending in a smaller number of countries, defined financial catastrophe as exceeding 40 percent of a household’s capacity to pay in any year. Researchers explored the extent to which countries relied on out-of-pocket payments to finance health care, or the proportion of a nation’s total health care spending funded through prepayments such as taxation, compulsory social health insurance (SHI), or voluntary insurance. Financial catastrophe can be reduced, the researchers say, when governments collect financial contributions to health care before someone falls ill and in accord with ability to pay, through either taxes or SHI. There is no evidence that SHI systems offered better or worse protection than tax-based systems did.

What’s In The Issue. The July-August issue of Health Affairs is the journal’s first thematic issue on global health. It includes articles by George Schieber and colleagues from the World Bank, William Hsiao of Harvard, and others, as well as country studies focusing on Thailand, Morocco, Brazil, Turkey, and Russia.

Highlights of the issue include the following:

AIDS Vaccine Development. Even a modestly effective, first-generation AIDS vaccine could have a profound impact on the epidemic, according to a new model developed by researchers from the International AIDS Vaccine Initiative and the Futures Institute. Researchers applied the model to Nigeria, South Africa, Mexico, Brazil, India, China, and Russia and then extended the results to the entire developing world. They found that a vaccine with 50 percent efficacy that was provided to nearly a third of the population would avoid 17 million new HIV infections between 2015 and 2030. http://content.healthaffairs.org/cgi/content/abstract/26/4/636

An AIDS vaccine with 70 percent effectiveness with expanded coverage of the population would reduce the number of new HIV infections by 28 million over the same 15-year period, the research suggests. The model considers that a partially effective vaccine would prevent some HIV infections and that where infections occurred, it would slow progression to AIDS and reduce contagiousness. Although expanded HIV prevention programs have had partial success in some countries, the AIDS epidemic still causes 2.8 million deaths per year.

Is Global Health Aid Effective? Christopher Lane and Amanda Glassman of the Brookings Institution explore how health aid is allocated to developing countries, whether this aid reflects recipients’ needs, and how the terms of financing affect the efficiency of aid. The researchers found that health aid is closely aligned in the aggregate with recipients’ aggregate disease burden and commitment to health, as defined by health spending as a percentage of general government spending. http://content.healthaffairs.org/cgi/content/abstract/26/4/935

However, health aid is disproportionately targeted to countries with smaller populations. A 1 percent population increase was associated with 0.4 percent less health aid per person. In addition, only certain types of diseases determine aid allocation. For example, nations with higher HIV/AIDS and tuberculosis burdens receive more aid per capita than others do. Most health aid is still short-term, volatile, unpredictable, highly fragmented, and tied to particular technologies or geographies, Lane and Glassman found.

Interview With Paul Farmer. The issue also features an interview with Paul Farmer, M.D., co-founder of Partners In Health, an international organization that works to provide care to the world’s poor. In a wide-ranging discussion with Fitzhugh Mullan, Farmer discusses the state of global health and how historical, political, and economic factors affect health care. http://content.healthaffairs.org/cgi/content/abstract/26/4/1062

Perceptions Of Health Status Depend On Relative Incomes Within Regions, Clifton And Gingrich Report In Health Affairs Web Exclusive

Despite considerable socioeconomic gaps and widely divergent levels of national health spending, people around the world express remarkably consistent levels of satisfaction with their personal health, regardless of where they live, according to findings from the Gallup World Poll spanning 130 countries. “Citizens of relatively undeveloped countries, where, for example, clean water and mosquito nets are real priorities, are just as satisfied with their personal health as those in developed countries,” write authors Jim Clifton, CEO of the Gallup Organization, and  Newt Gingrich, founder of the Center for Health Transformation, in a new Health Affairs Web Exclusive. Their paper will be available on the Health Affairs Web site on Tuesday, July 17, at 12:01 a.m., at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.5.w545.

Clifton and Gingrich note that older respondents reported markedly lower levels of satisfaction with their health status. The authors also say that satisfaction with health status increases with household income relative to others in the same region. “Those in the lowest income bracket in the United States earn on average nearly six times as much as those in the middle bracket in sub-Saharan Africa, yet they are much less likely to give favorable responses regarding their personal health,” Clifton and Gingrich write.


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2007 Project HOPE–The People-to-People Health Foundation, Inc.