Much variation in per capita health care spending levels can be observed in Asia-Pacific countries and territories in 2015 (), ranging from Bangladesh health spending per capita of only 88 international dollars (USD PPP) to Australia’s 4 491 international dollars (USD PPP). The average OECD current health spending per capita in 2015 was around twenty times that of the low-income countries and territories in Asia-Pacific (3 800 versus USD  PPP 193). The higher the income level of a country the higher the share of health spending per capita funded by government/compulsory sources in Asia-Pacific: 71.6% in high-income countries versus 36.8% in low and lower-middle income countries.

Health care can be paid for through a variety of financing arrangements. In some countries, health care might be predominantly financed through government schemes by which individuals are automatically entitled to care based on their residency. In other cases, compulsory health insurance schemes (either through public or private entities) linked to the payment of social contributions or health insurance premiums finance the bulk of health spending. In addition to these, a varying proportion of health care spending consists households’ out-of-pocket payments – either as standalone payments or as part of co-payment arrangements – as well as various forms of voluntary payment schemes such as voluntary health insurance.

On average, the share of health spending paid out-of-pocket has fallen by around 2 percentage points to 21.4% and 25.6% in high- and upper-middle income Asia-Pacific countries since 2010, whereas it has increased from 47.1% to 48.2% in low and lower-middle income Asia-Pacific countries (). The trend is quite diverse across the countries and the territories in the study. However, more than two thirds of the Asia-Pacific countries and territories reported a decrease, including between 7 and 10 percentage points for Papua New Guinea, Singapore and Indonesia, while Mongolia and Lao PDR reported a growth of around 10 percentage points in the same period. For each dollar spent on health, more than 60 centimes were “out-of-pocket” in Nepal, Bangladesh, Pakistan, India and Myanmar in 2015.

Despite the commitment to a national medicines policy in many countries in the Asia-Pacific region, progress on the implementation of these policies has been slow (Asia-Pacific Conference on national medicine policies, 2012). For millions of people in those countries, problems of access to essential medicines remain. Medicines are often not available or affordable and they may be low quality products which may also be inappropriately used in practice. Household out‐of‐pocket expenses on medicines account for a substantial proportion of total health care expenditures, and for many people on lower incomes, these out-of-pocket expenses push them below the poverty line and further their financial hardship (WHO Office for South-East Asia, 2017).