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About a year ago, this reporter spent some time between jobs. As part of his cost-saving measures, he decided to take a somewhat calculated risk and cancel his health insurance plan. His existing savings would be sufficient to cover any out-of-pocket payments (OPP), and his age and state of health meant that the likelihood of him falling ill was - in his opinion - negligible. Fortunately, he got away with it - as do many other people in his situation in affluent countries where health insurance is not mandatory. In other parts of the world, one is not always so lucky as to live in safe, clean environments, where parents and loved ones can foot the bill for some time. In some regions, out-of-pocket payments for medicines could be equivalent to a whole day’s food budget. The financial impact deepens significantly when illnesses become chronic, and treatments are needed on a continuous, daily basis.

Chronic non-communicable diseases (NCDs) such as heart and lung conditions are a global phenomenon on the rise. Currently, about 28 million people die annually in low- and middle-income countries due to these often-preventable diseases. Increasingly sedentary lifestyles and ignorance about good health habits mean that resources are now being restructured to accommodate the needs of the changing medical environment. About half the world’s population currently pays for healthcare out-of-pocket: before receiving any care. Patients with chronic diseases are facing increasingly difficult challenges at coping with frequent OPPs for a condition they can barely afford, while also providing for their families. A study to be presented at the 2012 Geneva Health Forum by Syed Abdul Hamid and his colleagues at the University of Dhaka, Bangladesh, shows that Bangladesh’s current OPP healthcare scheme is actually pushing some patients with chronic illnesses below the poverty line (7.7 percent of the people surveyed for their study). This means people tend to forgo treatments and medicine to provide food for their families. Those who do obtain medication sometimes render it useless by spreading out a day’s dosage over several, or come up with other approaches to stretch the supply further.

Unless things change, with chronic diseases on the rise and patients having difficulties in bearing the financial burden, healthcare is not going to become more accessible, and even more people will be driven towards poverty. In a world where the price of medication can vary significantly - even in different regions on the same continent - and with international funds going towards subsidizing drugs for cancer and HIV (rather than more ‘mundane’ maladies such as diabetes and hypertension), the problem of affordable healthcare is becoming even more acute.

UHC (Universal Health Care) Forward, a non-profit universal healthcare advocacy group, promotes three pillars of universal healthcare: reducing OPPs, pre-payment plans and pooling risk. Schemes like the ones they advocate are already in place in many developed countries, but are far more challenging to implement in parts of the world that lack man-power and financial resources - not to mention the backing of a stable political system. The hope is that innovations such as the ones presented at the Geneva Health Forum will some day lead to affordable and comprehensive health systems all over the world.

Read more about UHC Forward here

The abstract of the Bangladesh paper on the Geneva Health Forum website

(Photo © P.K. Lee/MSF)

With many thanks to Dr Slim Slama for his very helpful clarifications used towards this article.