Affordability in Health Care: Operationalizations and Applications in Different Contexts
(2013; 192 pages)

Erasmus Universiteit Rotterdam

Abrégé

Over the last decades, total health expenditures have increased significantly (Meltzer, 2001; Folland et al., 2004). Governments in low- and middle-income countries (LMICs) as well as in high-income countries face the difficult challenge of ensuring that necessary interventions are accessible for those who need them, while keeping care affordable. Since good quality health care and new medical interventions can be expensive, the process of balancing the goals of ensuring access to good quality health care for all citizens and ensuring affordability of health care is a difficult one (Weale, 1998).

The need for both efficient financing and budget allocation in health care hence is ever increasing. Economic resources being limited, the issue of how health care can be organized in an affordable manner is at the heart of many policy discussions. It is ultimately also scarcity that forces politicians and policymakers alike to decide on how to organize health care, what interventions to implement and how to finance them. This is a daunting task since setting priorities or rationing care which encompasses “explicit and regular attempts to define how much of which services should be provided and moving resources between services” (Hunter, 1997), clearly are unpopular topics among constituents. Although both LMICs and high-income countries are confronted with issues of scarcity and affordability, the degree of scarcity obviously differs between these countries. The main aim of this thesis is to contribute to the understanding of the role and importance of affordability in relation to choices in health care and to its measurement. This thesis does so through several studies in both LMICs and high-income countries.

 
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