Research Article: Quantifying the Impoverishing Effects of Purchasing Medicines: A Cross-Country Comparison of the Affordability of Medicines in the Developing World

Date Published: August 31, 2010

Publisher: Public Library of Science

Author(s): Laurens M. Niëns, Alexandra Cameron, Ellen Van de Poel, Margaret Ewen, Werner B. F. Brouwer, Richard Laing, Joshua A. Salomon

Abstract: Laurens Niëns and colleagues estimate the impoverishing effects of four medicines in 16 low- and middle-income countries using the impoverishment method as a metric of affordability and show that medicine purchases could impoverish large numbers of people.

Partial Text: In developing countries the cost of medicines accounts for a relatively large portion of total healthcare costs [1]–[4]. As the majority of people in developing countries do not have health insurance [5] and medicines provided free through the public sector are often unavailable [4], medicines are often paid for out of pocket at the time of illness. Consequently, where medicine prices are high, people may be unable to procure them and therefore forego treatment or they may go into debt. For this reason, the World Health Organization (WHO) has designated affordable prices as a determinant of access to medicines (together with rational selection and use, sustainable financing, and reliable health and supply systems) [6]. In several international treaties, access to healthcare has been established as a right [7],[8]. States have a legal obligation to make essential medicines available to those who need them at an affordable cost. Determining the degree of affordability of medicines, especially in low- and middle-income countries (LICs and MICs), is an important, yet complex undertaking as affordability is a vague concept.

Our measurement of the affordability of medicines is based on the approach taken by Van Doorslaer et al. [3], who reassessed poverty estimates in 11 Asian countries after taking into account household expenditures on health care. The impoverishment approach has also been used in other fields of study such as housing affordability [12],[13] and health insurance [14].

Table 3 presents the percentages of the population that are pushed below the poverty line owing to the purchasing of each of the four study medicines, both LPG and OB products.

The results illustrate that substantial proportions of the population would be pushed into poverty as a result of medicine procurement, implying that in many countries affordability of these treatments is low. In the private sector, LPGs were generally substantially more affordable than OB products. Thus, increasing the use of quality-assured generics could reduce the impoverishing effect of medicines. This use of generics, in turn, could bring about improvements in the health status of these populations by avoiding low compliance to recommended dosages or duration of treatment, resulting in problems such as sustained hypertension, elevated blood glucose levels, or the promotion of bacterial resistance due to too short courses of antibiotics.



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