ISLAMABAD, Feb 16: The annual out-of-pocket spending on medical care in Pakistan, which comes to around 5 per cent of total household expenditures, is among the highest such spending in Asian and the Pacific region countries, according to the Asian Development Bank.

In a report titled ‘Impact of Out-of-Pocket Expenditures on Families and Barriers to Use of Health Services in Pakistan’, the ADB said that spending on medicine and supplies accounted for 37pc of the household expenditure and therefore resulted in significant financial burden for many families.

The report says the incidence of catastrophic and impoverishing medical expenditures in Pakistan is high compared to other regional countries, although comparable to India.

The ADB says a government survey — PSLSMS 2005-06 — reveals high levels of both impoverishing and catastrophic impacts from out-of-pocket expenditures on health in Pakistan. In any given month in 2005-06, 4.7pc of the population, or 7.5 million Pakistanis, were pushed below the $1 international poverty line as a result of their household medical spending. According to the report, this is a high level of medical impoverishment by regional standards, comparable with 3.7pc in India, 3.1pc in Bangladesh and 0.2pc in Timor-Leste.

It says although rich households spend more on medical treatment than the poor ones, the burden is much greater for poor families than the rich. Healthcare spending as a share of household consumption is higher in poor households, and as a share of non-food consumption is even greater.

Citing example, it says the poor quintile devotes 8.3pc of their non-food expenditures to medical treatment against 5.9pc in the richest quintile.

It is likely that use of maternal and child health services in Pakistan frequently impoverishes families and acts as an impediment to greater use of medical services, as it does in India. Consequently, both lack of physical access to nearby healthcare facilities and the financial costs of treatment needed to be addressed to improve utilisation of maternal and child health services, according to the report.

It says the overall inequality in healthcare use is not great between the rich and the poor, but because poor Pakistanis are in worse health, there exists considerable inequity in access and use of services.

Private healthcare providers in the country are the dominant source of treatment with government healthcare services only accounting for one-fifth of overall use.

The main reason for not using government facilities, including for the poor, are lack of access and distance to state-run facilities followed by lack or inadequate supply of medicines.

However, overall use of government services appears to be pro-poor, although still at a low level.