The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review

Overview

Each year, globally, around 150 million people struggle to meet the costs of accessing and using health care and approximately 100 million people are driven below the poverty line by such costs. Many people delay or avoid health care because it is – or, at least, is perceived to be – unaffordable. Most of those who struggle to meet the out-of-pocket costs of health care live in low-income countries that have poorly funded health systems and inadequate measures to ensure the financial protection of households against high health-care expenditure. However, the problem is not limited to such countries. In 2007, for example, 62% of the personal bankruptcies recorded in the United States of America (USA) were attributed to medical debt and 11% of the individuals found insolvent in Australia cited ill-health or lack of health insurance as the primary reason for their insolvency. Substantial and unpredictable one-off health-care payments and a steady flow of unbudgeted medical bills can lead many households – particularly those already marginalized by socioeconomic disadvantage – towards catastrophic health-care expenditure