When spending on health leaves us penniless
A catastrophic illness is a severe illness that requires prolonged hospitalisation and/or recovery, for example, heart attack, stroke, cancers, etc.
These illnesses incur high expenditure for the patient, family and healthcare facility, and may incapacitate the patient from working, leading to catastrophic health expenditure.
According to the World Health Organization (WHO), “a household has catastrophic health expenditure (CHE) when its out-of-pocket health payments equal or exceed 40% of its non-subsistence expenditure, or what is called its capacity to pay”.
CHE is associated with some households having to borrow money or sell assets to finance their healthcare; earning less due to deteriorated health condition(s); are impoverished after paying for healthcare services; and some households who are already below the poverty line, become even poorer due to healthcare payment.
The reports of CHE studies in Malaysia are disturbing, to say the least.
A multi-institutional team studied whether current health coverage extended to catastrophic illnesses that inevitably incur CHE and found that the coverage varies from universal for dialysis, cataract surgery, medicines for organ transplant and chronic myeloid leukaemia, to practically none for hepatitis C, stroke, psoriasis and epilepsy surgery.
Coverage of targeted therapies for solid cancers, knee replacement surgery, anti-tumour necrosis factor for arthritis and coagulation factors for haemophilia were poor, while iron chelation for thalassaemia, coronary revascularisation, epoetin and anti-retrovirals were barely adequate.
The authors concluded: “Coverage for catastrophically costly treatments is uneven and inequitable in Malaysia, despite most of these being affordable. Decisions on coverage are driven by political-economic consideration.”
The 2012–2014 Asean Costs in Oncology Study prospectively followed-up 9,513 newly diagnosed cancer patients from eight countries for 12 months.
The overall and country-specific incidence of financial catastrophe, i.e. out-of-pocket health costs (equal or more than 30% of annual household income), economic hardship (inability to make necessary household payments), poverty (living below the national poverty line) and all-cause mortality, were determined.