Health Policy and Planning, Vol 13, 371-383, Copyright © 1998 by Oxford University Press
D Hotchkiss, J Rous, K Karmacharya and P Sangraula
His Majesty's Government of Nepal has embarked on an ambitious social
welfare programme of increasing the accessibility of primary education and
health care services in rural communities. The implications on the
financing of health care services are substantial, as the number of health
posts has increased twelve-fold from 1992 to 1996, from 200 to 2597. To
strengthen health care financing, government policy-makers are considering
a number of financing strategies that are likely to have a substantial
impact on household health care expenditures. However, more needs to be
known about the role of households in the current structure of the health
economy before the government designs and implements policies that affect
household welfare.This paper uses the Nepal Living Standards Survey, a
rich, nationally-representative sample of households from 1996, to
investigate the level and distribution of household out-of-pocket health
expenditures. Utilization and expenditures for different types of providers
are presented by urban/rural status and by socioeconomic status. In
addition, the sources of health sector funds are analyzed by contrasting
household out-of-pocket expenditures with expenditures by the government
and donors. The results indicate that households spend about 5.5% of total
household expenditures on health care and that households account for 74%
of the total level of funds used to finance the health economy. In
addition, rural households are found to spend more on health care than
urban households, after controlling for income status. Distributing health
care expenditures by type of care utilized indicates that the wealthy, as
well as the poor, rely heavily on services provided by the public sector.
The results of this analysis are used to discuss the feasibility of
implementing alternative health care financing policies.
ARTICLES
Household health expenditures in Nepal: implications for health care financing reform
School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA; Dept of Economics, University of North Texas, USA; Central Bureau of Statistics, His Majesty's Government of Nepal
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