On average, the share of health spending paid out-of-pocket has fallen in countries of all income groups in Asia-Pacific between 2015 and 2021: by around 5 percentage points to 43.1% in low- and lower-middle‑income countries, by 4 percentage points to 24.1% in upper-middle‑income countries and by around 3 percentage points to 16% in high-income countries (Figure 6.6). The pattern is quite diverse across the countries in the region, and could also be attributed to increasing unmet needs because of access barriers and/or financial constraints, as well as the aforementioned financial impact of the COVID‑19 pandemic on health budgets. Almost half of the Asia-Pacific reporting countries showed a decrease in the share of out-of-pocket spending, including more than 10 percentage points for Lao PDR, India, Singapore and Indonesia, and no countries reported an increase over the same period. However, for each dollar spent on health, more than 70 cents continued to be financed “out-of-pocket” in Bangladesh and Myanmar in 2021.
Research (Wang, Torres and Travis, 2018[1]) suggest that the main driver of households’ out-of-pocket expenditure is medicines, composing more than 60% of total out-of-pocket spending in countries of the WHO South-East Asia Region. In Bangladesh and India, this percentage could be as high as 68% and 42%, respectively (Ambade et al., 2022[2]; WHO, 2024[3]) Furthermore, the share of OOP spending on medicines was even higher among the poorer population, suggesting a disproportionally higher financial burden. In line with these findings, WHO and The World Bank has reported that the WHO South-East Asia and Western Pacific regions had the highest percentage of the population in the world facing catastrophic health spending – defined as out of pocket health spending exceeding the 10% of total income or expenditure1 – in 2019, pushing more people below the relative poverty line (WHO; World Bank, 2023[4]). Figure 6.7 shows that health expenditure by other voluntary payment schemes (e.g. PHI, spending by NGOs) represented – on average – around 10% of current expenditure on health in countries of all income groups in Asia-Pacific. This share increased by less than half a percentage point to 12.7% in upper-middle‑income countries, whereas it decreased by 1 percentage point to 6.9% in high-income countries, and slightly increased to 9.1% in low- and lower-middle‑income Asia-Pacific countries from 2015 to 2021. Less than 5% of current health expenditure was from voluntary payment schemes in Mongolia, Japan, Bangladesh and Brunei in 2021, while it represented 15% or more in Thailand, Viet Nam and Papua New Guinea in the same year. China reported an increase of 6.7 percentage points between 2015 and 2021, whereas Indonesia and Cambodia reported a decrease of more than 6 percentage points during the same period.
