• Linkages between health and social protection

Linkages between health and social protection

This article, published in Tropical Medicine and International Health, examines the issues surrounding “iatrogenic poverty” – poverty caused by spending on medical treatment. In countries which have moved from a planned to a market economy, access to health care has become more dependent on ability to pay; demand for medical services has grown rapidly; and it has become easier for households to use risky strategies to pay for health care, such as mortgaging or selling their assets. Consequently, in countries such as Cambodia and China, health care costs are now among the most important causes of household poverty.

Noting the growing interest in voluntary insurance schemes as a way of financing health care, the article argues that these schemes will take years to consolidate and go to scale, and if they are not well-designed will contribute to rapid cost escalation. Measures such as rationing, empowerment of patients through health education, and registration of medical workers would help. But in order to address the problems of health care-induced poverty, the article argues that a straightforward transfer of resources to the poor is needed. It also contends that fee waivers for the poor have often not worked, and identifies promising alternative schemes that are currently being developed.

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