Traditional Medicine in Asia

Traditional Medicine in Asia
Many studies in developing countries
indicate that health care utilization rates
among both poor and non-poor individuals
would not be significantly affected by small
increases in user fees. 53 In addition, many
studies suggest that health care utilization
would actually increase if increased user
fees are accompanied by improvements in
service. 53
However, other research indicates that
the price elasticity among the poor is
substantial, which suggests that user fee
schemes would have a regressive distributional
impact. 53
In many developing countries people
are expected to contribute to the cost of
health care from their own pockets. As a
result, people’s ability to pay (ATP) for
health care, or the affordability of health
care, has become a critical policy issue in
developing countries. It is particularly
urgent where households face combined
user fee burdens from various essential
service sectors such as health, education
and water. Research and policy debates
have focused on willingness to pay (WTP)
for essential services, and have tended to
assume that WTP is synonymous with ATP.
However, this assumption has been
questioned and it has been suggested that
WTP may not reflect ATP. 7 As noted in the
introductory section of this chapter,
households may persist in paying for care,
but to do so may sacrifice other basic needs
such as food and education. This in turn
can have serious consequences for the
household and individuals within it. In terms
of a social benefit analysis, the opportunity
costs of payment make the payment
“unaffordable” because other basic needs
are sacrificed.
In this regard, research into the
economics of health care utilization should
shift the focus of attention from the health
facility – including Government and private
174
TRM clinics – to the household. It is in
households that decisions are made on
how to allocate limited resources to health,
education and other essential commodities.
In Vietnam there is a rural expression
that TRM can be paid for with one chicken,
modern medicine can cost one cow and
hospitalization can cost a family its herd of
cows. Translating this into immediate and
downstream income benefits, such
sacrifices by poor families may be made at
the expense of their future livelihood.
Fees charged by traditional healers vary
greatly and can also be high. In South Africa,
for example, where payment is not exclusively
monetary, the healer may receive a cow on
curing the patient. The treatment for a
condition such as umtsebulo – presumed
soul loss – can cost US$ 125. 54
An approach to ATP, founded on basic
needs and the opportunity costs of payment
strategies (including non-utilization), has
been proposed. Common household
responses to payment difficulties have been
found to range from borrowing to more
serious “distress sales” of productive assets
(e.g., land), delays to treatment and,
ultimately, abandonment of treatment.
Although these strategies may have a
devastating impact on livelihoods and
health, few studies have investigated them
in any detail. In-depth longitudinal
household studies would develop an
understanding of ATP and could inform
policy initiatives which might contribute to
the development of affordable models of
THC services.
Potential Conflicts Arising from
Allocation of Resources to
Traditional Health Care Services
Resentment can arise from under-funded
sections of the modern medical sector
when resources are allocated to the
development of traditional medicine. A