Objectives: We assessed the contribution of health insurance and a functioning
public sector to access to care and medicines and household economic burden.
Methods: We used descriptive and logistic regression analyses on 2002/3 World
Health Survey data in 70 countries.
Results: Across countries, 286,803 households and 276,362 respondents
contributed data. More than 90% of households had access to acute care. However, less than half of respondents with a chronic condition reported access. In 51 low and middle
income countries (LMIC), health care expenditures accounted for 13–32% of total 4-week household expenditures. One in four poor households in low income countries incurred
potentially catastrophic health care expenses and more than 40% used savings, borrowed
money, or sold assets to pay for care. Between 41% and 56% of households in LMIC spent
100% of health care expenditures on medicines. Health insurance and a functioning public
sector were both associated with better access to care and lower risk of economic
burden. Conclusion: To improve access, policy makers should improve public sector
provision of care, increase health insurance coverage, and expand medicines benefit policies
in health insurance systems.