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‘Extreme risk’ African countries dominate Maplecroft’s Healthcare Coverage Index

Western Europe has best coverage but ageing populations present on-going risks

14/07/2011

A new index assessing 131 countries on their levels of healthcare coverage and social health protection has rated 32 nations rated as ‘extreme risk,’ with Sub-Saharan Africa home to 75% of them. South Asian Bangladesh, India, Nepal and Pakistan are also in the highest risk category, while Western Europe hosts nine out of the 10 best performing countries.

The Healthcare Coverage Index has been developed by risk analysis and mapping firm Maplecroft to enable companies to evaluate levels of healthcare, in countries around the world and to derive from this an assessment of the subsequent impacts on the wellbeing of workforces. The index is calculated using seven indicators grouped around the following three themes: level of coverage and financial protection, availability of healthcare and quality of services, and health outcomes.

The 10 countries with the lowest levels of healthcare coverage are all located in Sub-Saharan Africa and are rated as ‘extreme risk’ in the index. These include: Democratic Republic of Congo (1), Central African Republic (2), Burundi (3), Guinea (4), Guinea-Bissau (5), Sierra Leone (6), Cote d'Ivoire (7), Mali (8), Chad (9) and Niger (10).

According to Maplecroft, these countries are characterised by a range of problems including poor governance and infrastructure, poverty, ongoing conflicts and systemic corruption; all of which restrict governments' ability to rule effectively and provide healthcare.

South Asia countries also feature in the ‘extreme risk’ category with Nepal (14) the worst performer, followed by Bangladesh (15), Pakistan (27) and the heavyweight BRICs economy of India (32).

Healthcare Coverage Index

Legend
Extreme Risk
High risk
Medium risk
Low risk
No Data

Rank	Country	Rating
1	DR Congo	Extreme
2	C.A.R	Extreme
3	Burundi	Extreme
4	Guinea	Extreme
5	Guinea-Bissau	Extreme

Rank	Country	Rating
6	Sierra Leone	Extreme
7	Côte d'Ivoire	Extreme
8	Mali	Extreme
9	Chad	Extreme
10	Niger	Extreme

© Maplecroft, 2011

The overwhelming majority of Indians, especially those in rural areas, are not covered by healthcare with the ILO estimating that only 6% of the population benefit from formal health protection. India also stands out for having high out-of-pocket expenditures, constituting 76% of total health expenditure in the country. Out-of-pocket expenditure refers to the obligation to pay directly for services at the moment of need. An over-reliance on direct payments at the time of need can act as a barrier to people accessing and receiving healthcare when they need it. According to the India Health Report 2010, 7-8% of households drop below the poverty line because of medical expenses.

“Healthcare coverage is a key issue in most countries both in terms of availability and financial protection,” said Maplecroft Analyst Siobhan Tuohy-Smith. “In terms of financial protection, in some countries individuals and their households suffer severe financial difficulties due to the high direct costs of paying for their care. According to the World Health Organisation, about 150 million people globally suffer financial catastrophe every year, while 100 million are pushed below the poverty line due to healthcare costs.”

Nine of the 10 countries with the highest level of healthcare coverage are all European. These are Luxembourg (131), Norway (130), Netherlands (129), France (128), Denmark (127), Germany (126), United Kingdom (125), Sweden (124), and Iceland (123). Canada (122) is the only non-European country in the 10 lowest risk countries.

Europe, particularly Western Europe, benefits from high levels of healthcare coverage, but many of these countries face challenges such as rising costs, increasing expectations and the impact on government debt of the 2008/09 financial crisis. However, Europe’s primary risk to healthcare levels comes from an ageing population, which is putting upward pressure on costs as well as reducing the viability of existing funding mechanisms. According to the United Nations World Population Ageing Report 2009, on average across Europe, the old-age dependency ratio is forecast to increase from 24 in 2009 to 47 in 2050; an increase of approximately 50%.

“Effective and universal healthcare can improve the health of the labour market increasing the capacity for income generation, economic growth and development benefiting employers, individuals and governments,” continues Tuohy-Smith. “The key challenge for countries is to determine how their health financing systems can provide sufficient financial risk protection to all of the population.”

Some countries are already working towards solutions to these problems. For example, Germany’s ageing population means wage and salary earners have declined as a proportion of the total population, making it more difficult to fund its social health insurance system from the traditional sources of wage-based insurance contributions. As a result, the government has injected additional funds to shore up the system.

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