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Affordability Analysis of Neurological Tests in 37 Countries Using Household Income Distributions

By Bryan N. Patenaude

Methodology:

In order to generate meaningful estimates for affordability of the various neurological tests in each country, the distribution of household income must be obtained. Knowing the distribution of household income allows for comparisons of affordability to be made both between countries and between income deciles of the population within each country. Looking at affordability at the decile level paints broad picture of access in terms of household income level. Given limited comparable data on household income by percentile, income distributions were constructed using per capita GDP (measured in current USD) and the most recent Gini index values obtained from the World Bank Databank. The method for constructing these income distributions is described in detail in a 2011 United Nations Development Programme report (Harttgen & Vollmer, 2011; Vollmer et al., 2010).

This procedure relies on two key assumptions: that income follows a lognormal distribution and that GDP per capita is a good proxy for mean income in a given country. Several studies have found a lognormal distribution to be suitable for modeling income distributions in numerous settings (Clementi & Gallegati, 2005; Souma, 2001). Additionally, GDP per capita is commonly used as suitable estimate of mean income in a country so this research will stick with that convention. Formally, the lognormal distribution given by LN(μ,σ) is the distribution of a random variable Y = exp(X) , where X is distributed normally with mean μ and standard deviation σ. For the purposes of this study, Y represents GDP per capita. The Gini coefficient, a common measure of income dispersion or income inequality, is defined in relation to the lognormal income distribution as:

G=2Φ ( σ√2 )−1

Where, G is the Gini coefficient, Φ is the cumulative distribution function of the standard normal distribution, and σ is the standard deviation of normally distributed natural logarithm of GDP per capita. From this measurement, the parameters of the μ and σ of the lognormal distribution LN(μ,σ) can be defined as:

μ=ln(E (Y ))−( σ2

2 )

σ=√2Φ−1(G+12 )

Where Y is GDP per capita. In order to adjust this distribution to reflect household disposable income, rather than purely individual income additional steps were taken. First, for simplicity labor’s share of income was assumed to be 2/3 of total income, an estimate stemming from economic theory (Kaldor, 1961; Solow, 1957; Johnson, 1954). Second, it was assumed that there were two wage earners per household. This means that average household earned income is 2/3 times double per capita GDP. Our income distribution mean and standard deviation were appropriately adjusted for these modifications to account for the multiplicative alteration. The mean and standard deviation of household income are then calculated from the basic formulae:

μY=exp [μ+( σ 2

2 )]

σ Y=√¿¿

Third, a measure of household subsistence was created. We defined household subsistence as the average number of members per household in each country multiplied by the international annual poverty line. The average number of members per household for each country was obtained from OECD Stat Extracts, UN Statistical Database, Eurostat, or DHS Stat Compiler. The international subsistence level was defined as an individual living on $1.25 USD per day by World Bank standards, which is equivalent to $456.25 USD per year (Ravallion, et al., 2008). This $456.25 per year is multiplied by the average number of household residents to get a measure for household subsistence in current USD. We assume that this is the bare minimum a household needs to have subsistence needs met and until household income surpasses such a level, there can be no disposable income.

The final stages of the income estimation involve subtracting household subsistence from the previously generated income distribution to get the distribution of household disposable incomes. This household disposable distribution is then split into deciles for analysis. Deciles are calculated from the lognormal distribution according to the equation:

x p=exp [μ+z pσ ]

Where x p is the percentile, z p is the z-score of the corresponding percentile from a standard normal distribution, and μand σ are the parameters of the lognormal distribution LN(μ,σ) described above.

To examine the affordability of the various neurological tests the cost of each test

to the patient under public and private sector insurance for each available country was converted into current USD. This dollar amount per test was then divided by household

disposable income at each decile to determine the percent of annual household disposable income that would be consumed on a given neurological test. This process was conducted for EEG, CT scan, MRI, EMG, and Lumbar Puncture for each country. Countries within our sample were then aggregated and averaged over World Bank income group, World Health Organization region, and OECD status (Figures 1 – 6).

Results and Discussion

Affordability was assessed at several different levels as a percentage of annual household disposable income including: less than 100%, less than 40%, less than 20%, and less than 10%. The WHO defines catastrophic health expenditure as spending on healthcare in excess of 40% of household disposable income (Xu, et al, 2003). Thus, affordability in a broad sense should be limited to below 40% of annual household disposable income and should more narrowly be defined as below 10% of annual household disposable income. Tables I – V display the percentage of household disposable income that each neurological test costs under public insurance for each income decile of the listed country’s population. Tables VI - X display the percentage of household disposable income that each neurological test costs under private insurance for each income decile of the listed country’s population. In both series of tables the last 5 columns display the percentage of the total population that is estimated to be able to afford the neurological test at below 100%, 40%, 20% and 10% of annual household disposable income and the final column is an estimate given by local physicians of the percent of their patients they believe can afford the given neurological test. Figures 1 – 6 display the percentage of the total population of our study that can afford a test at below the 10% level of annual household disposable income by World Bank income group, World Health organization region, and OECD status.

As displayed in Tables 1 - X below, costs to the patient are generally lower for all neurological tests in the public system as opposed to the private system and are thus more affordable to patients in public systems. For all neurological tests the countries Bangladesh, Burkina Faso, Somalia, Ethiopia, Myanmar, and Zimbabwe have the poorest access and affordability with only about the top 10% or 20% of the population being able to afford neurological tests at below catastrophic healthcare expenditure levels. Countries such as Ghana, Nigeria, Zambia, South Africa, and Namibia, while having higher affordability than the first group of countries, still only meet accessibility standards for less than 60% of their populations, on average. OECD countries including the Netherlands, Iceland, Japan, Czech Republic, and Canada as well as countries such as Brazil, Israel, Iran, and Kuwait all have extremely high affordability with between 80% and 100% of their total populations being able to afford neurological tests with less than 10% household expenditure of disposable income.

Examining affordability by World Bank income group, it is clear that affordability decreases sharply with income level (Figures 1 & 2). High income countries surveyed have between 80% and 100% of their total populations able to afford all of the neurological tests at less than 10% of their annual household disposable income while in low income countries only 0% to 20% of the total population can afford any of the

neurological tests, at less than 10% of their annual household disposable income. These data also demonstrate that the discrepancy in affordability between prices of tests charged to the patient under private and public insurance is most pronounced in Upper-Middle Income and Lowe-Middle Income countries (Figure 2). This would seem to indicate that most of the populations in the surveyed High Income countries can afford neurological tests both under public and private insurance schemes, while most of the populations in the surveyed Low Income countries cannot afford neurological tests under either public or private insurance schemes.

Grouping the data by WHO region, demonstrates high affordability of neurological tests was visible in surveyed countries within the Americas, Western Pacific, and Europe regions, with most tests estimated to be affordable for greater than 70% of the total populations. The lowest affordability for all neurological tests among countries surveyed were in the Africa and Southeast Asia regions with the majority of tests being affordable by less than 50% of the total population of surveyed countries at below 10% of annual household disposable income (Figures 3 & 4).

Regrouping the data by OECD Status demonstrates that OECD countries surveyed have higher affordability on average than non-OECD countries. OECD countries surveyed had affordability for all neurological tests in both the public and private sectors for over 80% of their total populations and at below 10% of household annual disposable income (Figures 5 & 6). Non-OECD countries surveyed had, generally, around 50% of their total populations able to afford the neurological tests, with greater variation in terms of affordability between public and private systems (Figure 6).

All results are estimated from income distributions based upon per capita GDP. It is often believed that income can provide an inaccurate measure of household wealth in developing countries, where many residents may not have employment within the formal economy. Thus, the affordability analysis should be interpreted with some caution. That said, the general trends depicted in the analysis appear to be consistent with both economic theory and observational evidence in developing countries. Additionally, given a lack of reliable and comparable data on household wealth for all countries surveyed, GDP per capita is perhaps the most consistent measure of household income for the purposes and context of this study. Another potential concern is applying the global poverty line to all countries. While the majority of the countries surveyed were not high-income countries, and thus the subsistence poverty line is likely applicable, when applied to developed countries the global poverty line may be too low. If the subsistence line is too low, we will overestimate affordability in higher income countries. Despite this potential criticism, there is evidence that affordability is so high in the higher income countries that even adjusting the poverty line used would not have too large of an effect on expenditures as a percent of annual household disposable income and since most tests were free in these high-income countries’ public systems, results would not be affected at all in terms of public affordability. Additionally, estimates of affordability in lower income countries, which are all between 0% and 20% of the total population will remain as previously estimated, given the proximity of the global poverty line to the domestic poverty lines of many low income countries. Thus, while adjusting the poverty line on a per-country basis would provide more precise estimates, using the international poverty

line still provides a general picture of the distribution of affordability worldwide of the neurological tests sampled. References:

Clementi, Fabio & Mauro Gallegati (2005). "Pareto's Law of Income Distribution: Evidence for Grermany, the United Kingdom, and the United States," Microeconomics 0505006, EconWPA.

Harttgen, Kenneth & Sebastian Vollmer (2011). "Inequality Decomposition without Income or Expenditure Data: Using an Asset Index to Simulate Household Income," Human Development Research Papers (2009 to present) HDRP-2011-13, Human Development Report Office (HDRO), United Nations Development Programme (UNDP).

Johnson, D. (1954) The Functional Distribution of Income in the United States, 1850- 1952, Review of Economics and Statistics, 36, 175-182.

Kaldor, N. (1961) Capital Accumulation and Economic Growth, in Lutz & Hague (ed.) The Theory of Capital, McMillan, London.

Ravallion, Martin; Chen, Shaohua; Sangraula, Prem. (2008), Dollar a Day Revisited (Report). Washington DC: The World Bank. Retrieved 10 June 2013.

Solow, R. (1957) Technical Change and the Aggregate Production Function, The Review of Economics and Statistics, 39, 3, 312-320.

Souma, W (2001). Universal Structure of the Personal Income Distribution. Fractals 9:463–470.

Vollmer, S., H. Holzmann and J. Weisbrod (2010). A Global Growth Incidence Analysis. Working paper. Available at: http://works.bepress.com/sebastianvollmer/

Xu K, Evans D, Kawabata K, Zeramdini R, Klavus J, et al. (2003) Household catastrophic health expenditure: A multicountry analysis. Lancet 362: 111–117.

CT

EEG

EMG

LP

MRI

CT

EEG

EMG

LP

MRI

CT

EEG

EMG

LP

MRI

CT

EEG

EMG

LP

MRI

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Figure 1: Average Percent Total Population That Can Afford Test at Below 10% of Annual Household Disposable Income by World Bank

Income Group

privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic privatepublic

CTEE

GEM

GLP

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ICT

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Figure 2: Average Percent Total Population That Can Afford Test at Below 10% of Annual Household Disposable Income by World Bank

Income Group and by Sector

CT

EEG

EMGLP

MRI

CT

EEG

EMG

LP

MRI

CT

EEGEMG

LP

MRI

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EEG

EMG

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LPMRI

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0 10 20 30 40 50 60 70 80 90 100

Figure 3: Average Percent of the Total Population That Can Afford Test at Below 10% of Annual Household Disposable

Income by WHO Group

public

public

public

public

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public

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public

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private

EEG

LPCT

EMG

MR

IEE

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CTEM

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0 10 20 30 40 50 60 70 80 90 100

Figure 4: Average Percent of the Total Population That Can Afford Test at Below 10% of Annual Household Disposable Income by

WHO Group and by Sector

Country

Cost of EEG in Public

Sector (Current

USD)

1st Income

Decile

2nd Income

Decile

3rd Income

Decile

4th Income Decile

5th Income Decile

6th Income Decile

7th Income Decile

8th Income

Decile

9th Income

Decile

Below 100% of

Disposable Income

Below Catastrophic Expenditure

(40% Disposable

Income)

Below 20% of

Disposable Income

Below 10% of

Disposable Income

Doctor's Estimate

of % That Can

Afford

Albania $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Bangladesh $12.80 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0%

Brazil $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%

Burkina Faso $40.48 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

Cuba $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Ethiopia $16.94 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

Ghana $30.00 > 100% > 100% > 100% > 100% 28% 6% 3% 2% 1% 50% - 60% 50% - 60% 40% - 50% 40% - 50% 75% - 90%

Iceland $78.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

India $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Iran $3.50 1% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Israel $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Jamaica $90.00 41% 9% 5% 4% 3% 2% 1% 1% 1% 90% - 100% 80% - 90% 80% - 90% 80% - 90% 75% - 90%

Kuwait $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Mexico $20.00 2% 1% 1% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Netherlands $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Nigeria $30.00 > 100% > 100% > 100% 11% 4% 2% 1% 1% 0% 60% - 70% 60% - 70% 60% - 70% 50% - 60% 50% - 75%

Pakistan $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Panama $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 0% - 25%

Peru $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Singapore $95.90 1% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

South Africa $4.00 > 100% > 100% > 100% 1% 0% 0% 0% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% 0%

Macedonia $3.23 > 100% 1% 0% 0% 0% 0% 0% 0% 0% 80% - 90% 80% - 90% 80% - 90% 80% - 90% 75% - 90%

Zambia $30.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% 5% 1% 20% - 30% 20% - 30% 20% - 30% 20% - 30% 25% - 50%

Zimbabwe $20.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 3% 10% - 20% 10% - 20% 10% - 20% 10% - 20% 25% - 50%

Canada $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Namibia $1.00 > 100% > 100% > 100% 0% 0% 0% 0% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% > 90%

Table I: Cost of EEG under Public Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford an EEG Table II: Cost of CT Scan under Public Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford a CT Scan

Country

Cost of CT Scan in

Public Sector

(Current USD)

1st Income Decile

2nd Income

Decile 3rd Income

Decile

4th Income

Decile

5th Income Decile

6th Income Decile

7th Income

Decile

8th Income

Decile

9th Income Decile

Below 100% of Disposable

Income


(40% Disposable

Income)

Below 20% of

Disposable Income


Income

Doctor's Estimate of % That Can

AffordAlbania $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Bangladesh $25.61 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%Bhutan $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Botswana $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Brazil $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 0% - 25% Burkina Faso $101.21 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Cuba $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Ethiopia $36.71 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Ghana $125.00 > 100% > 100% > 100% > 100% > 100% 25% 12% 7% 4% 40% - 50% 40% - 50% 30% - 40% 20% - 30% 50% - 75%Haiti $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Iceland $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%India $3.41 > 100% > 100% > 100% > 100% > 100% > 100% 4% 1% 0% 30% - 40% 30% - 40% 30% - 40% 30% - 40% 50% - 75%Iran $6.00 2% 1% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Israel $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Jamaica $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Japan $60.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%Kuwait $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Lao $101.78 > 100% > 100% > 100% > 100% > 100% > 100% > 100% 26% 7% 20% - 30% 20% - 30% 10% - 20% 10% - 20% 25% - 50%Mexico $150.00 17% 7% 4% 3% 2% 2% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 80% - 90% 75% - 90%Netherlands $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Nigeria $206.00 > 100% > 100% > 100% 76% 26% 14% 9% 6% 3% 60% - 70% 50% - 60% 40% - 50% 30% - 40% 25% - 50%Pakistan $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Panama $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 0% - 25% Peru $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Singapore $159.83 1% 1% 1% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%South Africa $4.00 > 100% > 100% > 100% 1% 0% 0% 0% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% 0%Macedonia $7.54 > 100% 1% 1% 0% 0% 0% 0% 0% 0% 70% - 80% 70% - 80% 70% - 80% 70% - 80% 75% - 90%Zambia $150.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% 26% 6% 20% - 30% 20% - 30% 10% - 20% 10% - 20% 0% - 25%

Percentage of Annual Household Income by Income Decile Percentage of Total Population That Can Afford

Percentage of Total Population That Can Afford Percentage of Annual Household Income by Income Decile

Zimbabwe $200.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 27% 10% - 20% 10% - 20% 0% - 10% 0% - 10% 0% - 25% Canada $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Namibia $1.00 > 100% > 100% > 100% 0% 0% 0% 0% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% > 90%

Table III: Cost of MRI under Public Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford an MRI

Country

Cost of MRI in Public Sector

(Current USD)

1st Income Decile

2nd Income Decile

3rd Income Decile

4th Income Decile

5th Income Decile

6th Income Decile

7th Income Decile

8th Income

Decile 9th Income

Decile

Below 100% of

Disposable Income


(40% Disposable

Income)


Income


Income

Doctor's Estimate of %

That Can Afford

Bangladesh $51.21 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Bhutan $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Botswana $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Brazil $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 0% - 25% Burkina Faso $374.46 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Ghana $250.00 > 100% > 100% > 100% > 100% > 100% 49% 24% 14% 8% 40% - 50% 30% - 40% 20% - 30% 10% - 20% 25% - 50%Iceland $121.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%India $51.20 > 100% > 100% > 100% > 100% > 100% > 100% 55% 9% 4% 30% - 40% 20% - 30% 20% - 30% 20% - 30% 25% - 50%Iran $10.00 3% 1% 1% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Jamaica $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Japan $78.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%Kuwait $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%Mexico $500.00 58% 22% 14% 10% 7% 5% 4% 3% 2% 90% - 100% 80% - 90% 70% - 80% 50% - 60% 25% - 50%Netherlands $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Nigeria $265.00 > 100% > 100% > 100% 98% 33% 18% 11% 7% 4% 60% - 70% 50% - 60% 40% - 50% 20% - 30% 25% - 50%Peru $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Singapore $639.34 4% 3% 2% 2% 1% 1% 1% 1% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%South Africa $1,000.00 > 100% > 100% > 100% > 100% 57% 31% 18% 11% 6% 50% - 60% 40% - 50% 30% - 40% 10% - 20% 0%Macedonia $15.09 > 100% 3% 1% 1% 1% 0% 0% 0% 0% 80% - 90% 80% - 90% 80% - 90% 80% - 90% 75% - 90%Zambia $250.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% 44% 11% 20% - 30% 10% - 20% 10% - 20% 0% - 10% 0% - 25% Canada $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Namibia $1.00 > 100% > 100% > 100% 0% 0% 0% 0% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% > 90%


Table IV: Cost of EMG under Public Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford an EMG

Country

Cost of EMG in Public Sector

(Current USD)

1st Income Decile

2nd Income Decile

3rd Income Decile

4th Income Decile

5th Income Decile

6th Income Decile

7th Income Decile

8th Income Decile

9th Income Decile


Income


(40% Disposable

Income)

Below 20% of

Disposable Income

Below 10% of

Disposable Income


AffordAlbania $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Bangladesh $12.80 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

Brazil $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%Burkina Faso $60.72 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

Cuba $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Ghana $75.00 > 100% > 100% > 100% > 100% 71% 15% 7% 4% 2% 40% - 50% 50% - 60% 40% - 50% 30% - 40% 50% - 75%

Iceland $78.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

India $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Iran $104.00 29% 10% 6% 4% 3% 2% 2% 1% 1% 90% - 100% 90% - 100% 80% - 90% 70% - 80% 75% - 90%

Israel $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Jamaica $225.00 > 100% 23% 13% 9% 6% 5% 4% 3% 2% 80% - 90% 80% - 90% 70% - 80% 60% - 70% 50% - 75%

Japan $18.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%

Kuwait $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Mexico $500.00 58% 22% 14% 10% 7% 5% 4% 3% 2% 90% - 100% 80% - 90% 70% - 80% 50% - 60% 25% - 50%

Netherlands $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Panama $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%

Peru $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Singapore $119.88 1% 1% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Macedonia $6.47 > 100% 1% 1% 0% 0% 0% 0% 0% 0% 80% - 90% 80% - 90% 80% - 90% 80% - 90% 75% - 90%

Zambia $30.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% 5% 1% 20% - 30% 20% - 30% 20% - 30% 20% - 30% 0% - 25%

Zimbabwe $50.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 7% 10% - 20% 10% - 20% 10% - 20% 10% - 20% 25% - 50%


Canada $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90%

Namibia $1.00 > 100% > 100% > 100% 0% 0% 0% 0% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% > 90%

Table V: Cost of Lumbar Puncture under Public Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford a Lumbar Puncture

Country

Cost of Lumbar

Puncture in Public

Sector (Current

USD)1st Income

Decile

2nd Income Decile

3rd Income Decile

4th Income Decile

5th Income Decile

6th Income Decile

7th Income Decile

8th Income Decile

9th Income Decile


Income


(40% Disposable

Income)

Below 20% of

Disposable Income

Below 10% of

Disposable Income


AffordAlbania $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Bhutan $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Botswana $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Brazil $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Burkina Faso $24.29 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 50% - 75%Cuba $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Ghana $50.00 > 100% > 100% > 100% > 100% 47% 10% 5% 3% 2% 50% - 60% 40% - 50% 40% - 50% 30% - 40% 75% - 90%Iceland $30.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%India $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Iran $4.00 1% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Israel $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Japan $6.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%Kuwait $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Mexico $250.00 29% 11% 7% 5% 4% 3% 2% 1% 1% 90% - 100% 90% - 100% 80% - 90% 70% - 80% 75% - 90%Myanmar $5.36 > 100% > 100% > 100% > 100% > 100% > 100% > 100% 7% 1% 20% - 30% 20% - 30% 20% - 30% 20% - 30% 75% - 90%Nigeria $17.00 > 100% > 100% > 100% 6% 2% 1% 1% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% 75% - 90%Pakistan $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Panama $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%Peru $25.00 9% 2% 1% 1% 1% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Singapore $159.83 1% 1% 1% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Uganda $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 0% - 25% Zambia $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Zimbabwe $20.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 3% 10% - 20% 10% - 20% 10% - 20% 10% - 20% > 90% Canada $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Namibia $1.00 > 100% > 100% > 100% 0% 0% 0% 0% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% > 90%


Table VI: Cost of EEG under Private Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford a EEG

Country

Cost of EEG in Private Sector

(Current USD)

1st Income Decile

2nd Income Decile

3rd Income Decile

4th Income Decile

5th Income Decile

6th Income Decile

7th Income Decile

8th Income Decile

9th Income Decile

Below 100% of

Disposable Income


(40% Disposable

Income)

Below 20% of

Disposable Income

Below 10% of

Disposable Income

Doctor's Estimate of %

That Can Afford

Albania $47.32 5% 3% 2% 2% 1% 1% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%

Bangladesh $25.61 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

Brazil $69.57 3% 2% 1% 1% 1% 1% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Burkina Faso $60.72 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Ethiopia $39.54 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 50% - 75%

Ghana $75.00 > 100% > 100% > 100% > 100% 71% 15% 7% 4% 2% 50% - 60% 40% - 50% 40% - 50% 30% - 40% 75% - 90%

India $12.80 > 100% > 100% > 100% > 100% > 100% > 100% 14% 2% 1% 30% - 40% 30% - 40% 30% - 40% 20% - 30% 50% - 75%

Iran $35.00 10% 3% 2% 1% 1% 1% 1% 0% 0% 90% - 100% 90% - 100% 90% - 100% 80% - 90% 50% - 75%

Jamaica $240.00 > 100% 25% 14% 10% 7% 5% 4% 3% 2% 80% - 90% 80% - 90% 70% - 80% 60% - 70% 75% - 90%

Jordan $125.00 44% 11% 7% 5% 4% 3% 2% 2% 1% 90% - 100% 80% - 90% 80% - 90% 70% - 80% 50% - 75%

Kuwait $299.74 1% 1% 1% 1% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Mexico $100.00 12% 4% 3% 2% 1% 1% 1% 1% 0% 80% - 90% 80% - 90% 80% - 90% 70% - 80% 25% - 50%

Netherlands $500.00 2% 1% 1% 1% 1% 1% 1% 1% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%

Pakistan $20.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 75% - 90%

Panama $200.00 41% 11% 6% 4% 3% 2% 2% 1% 1% 90% - 100% 80% - 90% 80% - 90% 70% - 80% 75% - 90%

Peru $150.00 51% 12% 7% 5% 3% 3% 2% 1% 1% 90% - 100% 80% - 90% 80% - 90% 70% - 80% 25% - 50%

Somalia $40.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%South Africa $70.00 > 100% > 100% > 100% 10% 4% 2% 1% 1% 0% 60% - 70% 60% - 70% 60% - 70% 50% - 60% 75% - 90%

Macedonia $32.33 > 100% 6% 3% 2% 1% 1% 1% 0% 0% 80% - 90% 80% - 90% 80% - 90% 80% - 90% 0% - 25%

Zimbabwe $100.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 14% 10% - 20% 10% - 20% 10% - 20% 0% - 10% 75% - 90%

Namibia $150.00 > 100% > 100% > 100% 32% 11% 6% 3% 2% 1% 60% - 70% 60% - 70% 50% - 60% 40% - 50% 50% - 75%


Table VII: Cost of a CT Scan under Private Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford a CT Scan

Country

Cost of CT Scan in Private Sector

(Current USD)

1st Income Decile

2nd Income

Decile

3rd Income

Decile 4th Income

Decile 5th Income

Decile 6th Income

Decile 7th Income

Decile 8th Income

Decile 9th Income

Decile

Below 100% of

Disposable Income


(40% Disposable

Income)

Below 20% of

Disposable Income

Below 10% of

Disposable Income

Doctor's Estimate

of % That Can Afford

Albania $141.95 14% 8% 6% 5% 4% 3% 3% 2% 2% 90% - 100% 90% - 100% 90% - 100% 80% - 90% 50% - 75%Bangladesh $51.21 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%Botswana $900.00 > 100% > 100% > 100% 64% 34% 21% 13% 8% 4% 60% - 70% 50% - 60% 30% - 40% 20% - 30% 50% - 75%Brazil $347.85 13% 8% 6% 4% 4% 3% 2% 2% 1% 90% - 100% 90% - 100% 90% - 100% 80% - 90% 50% - 75%Burkina Faso $121.45 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Ethiopia $84.72 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%Ghana $175.00 > 100% > 100% > 100% > 100% > 100% 34% 17% 10% 5% 40% - 50% 40% - 50% 30% - 40% 10% - 20% 75% - 90%Haiti $200.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 43% 10% - 20% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Iceland $104.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%India $25.60 > 100% > 100% > 100% > 100% > 100% > 100% 28% 4% 2% 30% - 40% 30% - 40% 20% - 30% 20% - 30% 25% - 50%Iran $40.00 11% 4% 2% 2% 1% 1% 1% 1% 0% 90% - 100% 90% - 100% 90% - 100% 80% - 90% 75% - 90%Israel $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Jamaica $250.00 > 100% 26% 15% 10% 7% 5% 4% 3% 2% 80% - 90% 80% - 90% 70% - 80% 50% - 60% 75% - 90%Japan $60.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%Jordan $90.00 32% 8% 5% 3% 3% 2% 2% 1% 1% 90% - 100% 90% - 100% 80% - 90% 80% - 90% 75% - 90%Kuwait $458.42 2% 1% 1% 1% 1% 1% 1% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Mexico $250.00 29% 11% 7% 5% 4% 3% 2% 1% 1% 90% - 100% 90% - 100% 80% - 90% 70% - 80% 75% - 90%Netherlands $800.00 3% 2% 2% 2% 1% 1% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%Pakistan $50.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 75% - 90%Panama $200.00 41% 11% 6% 4% 3% 2% 2% 1% 1% 90% - 100% 80% - 90% 80% - 90% 70% - 80% 75% - 90%Peru $250.00 86% 20% 12% 8% 6% 4% 3% 2% 2% 90% - 100% 80% - 90% 70% - 80% 60% - 70% 25% - 50%Somalia $150.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%South Africa $100.00 > 100% > 100% > 100% 14% 6% 3% 2% 1% 1% 60% - 70% 60% - 70% 60% - 70% 50% - 60% 75% - 90%Macedonia $75.44 > 100% 13% 6% 4% 3% 2% 1% 1% 1% 80% - 90% 80% - 90% 80% - 90% 70% - 80% 0% - 25% Zimbabwe $400.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 55% 10% - 20% 0% - 10% 0% - 10% 0% - 10% 50% - 75%Canada $582.64 2% 2% 1% 1% 1% 1% 1% 1% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% > 90% Namibia $550.00 > 100% > 100% > 100% > 100% 40% 21% 12% 7% 4% 50% - 60% 40% - 50% 30% - 40% 20% - 30% 50% - 75%


Table VIII: Cost of an MRI under Private Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford an MRI

Country

Cost of MRI in

Private Sector

(Current USD)

1st Income Decile

2nd Income

Decile

3rd Income

Decile

4th Income Decile

5th Income Decile

6th Income Decile

7th Income Decile

8th Income Decile

9th Income

Decile

Below 100% of

Disposable Income


(40% Disposable

Income)

Below 20% of

Disposable Income

Below 10% of

Disposable Income

Doctor's Estimate

of % That Can Afford

Albania $236.59 23% 14% 10% 8% 6% 5% 4% 4% 3% 90% - 100% 90% - 100% 80% - 90% 60% - 70% 50% - 75%Bangladesh $89.62 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%Botswana $1,200.00 > 100% > 100% > 100% 85% 45% 28% 18% 11% 6% 60% - 70% 40% - 50% 30% - 40% 10% - 20% 50% - 75%Brazil $417.42 15% 9% 7% 5% 4% 3% 3% 2% 2% 90% - 100% 90% - 100% 90% - 100% 80% - 90% 50% - 75%Burkina Faso $374.46 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Ethiopia $127.08 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%Ghana $300.00 > 100% > 100% > 100% > 100% 284% 59% 29% 16% 9% 40% - 50% 30% - 40% 20% - 30% 10% - 20% 75% - 90%Haiti $600.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 130% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 0% - 25% Iceland $600.00 2% 2% 1% 1% 1% 1% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%India $85.33 > 100% > 100% > 100% > 100% > 100% > 100% 92% 14% 6% 30% - 40% 20% - 30% 20% - 30% 10% - 20% 25% - 50%Iran $50.00 14% 5% 3% 2% 2% 1% 1% 1% 0% 90% - 100% 90% - 100% 90% - 100% 80% - 90% 50% - 75%Jamaica $350.00 > 100% 36% 21% 14% 10% 8% 6% 4% 3% 80% - 90% 80% - 90% 60% - 70% 40% - 50% 75% - 90%Japan $78.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%Jordan $180.00 63% 16% 10% 7% 5% 4% 3% 2% 2% 90% - 100% 80% - 90% 80% - 90% 60% - 70% 75% - 90%Kuwait $528.95 2% 1% 1% 1% 1% 1% 1% 1% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%Mexico $1,000.00 > 100% 44% 27% 19% 14% 11% 8% 6% 4% 80% - 90% 70% - 80% 60% - 70% 30% - 40% 50% - 75%Netherlands $900.00 3% 3% 2% 2% 2% 1% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%Peru $300.00 > 100% 24% 14% 9% 7% 5% 4% 3% 2% 80% - 90% 80% - 90% 70% - 80% 60% - 70% 0% - 25% Somalia $175.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%South Africa $1,000.00 > 100% > 100% > 100% > 100% 57% 31% 18% 11% 6% 50% - 60% 40% - 50% 30% - 40% 10% - 20% 75% - 90%Macedonia $161.65 > 100% 29% 13% 8% 6% 4% 3% 2% 1% 80% - 90% 80% - 90% 70% - 80% 60% - 70% 0% - 25% Canada $873.96 4% 3% 2% 2% 2% 1% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%


Country

Cost of EMG in Private Sector

(Current USD)

1st Income Decile

2nd Income Decile

3rd Income

Decile

4th Income

Decile

5th Income Decile

6th Income

Decile

7th Income

Decile

8th Income Decile

9th Income Decile

Below 100% of

Disposable Income


(40% Disposable

Income)

Below 20% of

Disposable Income

Below 10% of

Disposable Income

Doctor's Estimate

of % That Can

Afford

Albania $47.32 5% 3% 2% 2% 1% 1% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Bangladesh $38.41 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

Brazil $92.76 3% 2% 2% 1% 1% 1% 1% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%Burkina Faso $60.72 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%Czech Republic $0.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Ethiopia $141.20 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

Ghana $150.00 > 100% > 100% > 100% > 100% > 100% 30% 14% 8% 5% 40% - 50% 40% - 50% 30% - 40% 20% - 30% 75% - 90%

Iceland $78.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

India $34.13 > 100% > 100% > 100% > 100% > 100% > 100% 37% 6% 2% 30% - 40% 30% - 40% 20% - 30% 20% - 30% 50% - 75%

Iran $50.00 14% 5% 3% 2% 2% 1% 1% 1% 0% 90% - 100% 90% - 100% 90% - 100% 80% - 90% 50% - 75%

Jamaica $350.00 > 100% 36% 21% 14% 10% 8% 6% 4% 3% 80% - 90% 80% - 90% 60% - 70% 40% - 50% 75% - 90%

Japan $18.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%

Jordan $150.00 53% 14% 8% 6% 4% 3% 3% 2% 1% 90% - 100% 80% - 90% 80% - 90% 70% - 80% 75% - 90%

Kuwait $335.00 1% 1% 1% 1% 1% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%

Mexico $600.00 70% 27% 16% 11% 8% 6% 5% 3% 2% 90% - 100% 80% - 90% 70% - 80% 50% - 60% 50% - 75%

Netherlands $600.00 2% 2% 1% 1% 1% 1% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%

Pakistan $20.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 75% - 90%

Panama $150.00 31% 8% 5% 3% 2% 2% 1% 1% 0% 90% - 100% 80% - 90% 80% - 90% 80% - 90% 75% - 90%

Peru $75.00 26% 6% 3% 2% 2% 1% 1% 1% 0% 90% - 100% 90% - 100% 80% - 90% 80% - 90% 25% - 50%

Somalia $45.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

South Africa $200.00 > 100% > 100% > 100% 28% 11% 6% 4% 2% 1% 60% - 70% 60% - 70% 50% - 60% 40% - 50% 75% - 90%

Macedonia $64.66 > 100% 11% 5% 3% 2% 2% 1% 1% 1% 80% - 90% 80% - 90% 80% - 90% 70% - 80% 0% - 25%

Zimbabwe $50.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 7% 10% - 20% 10% - 20% 10% - 20% 10% - 20% 75% - 90%

Namibia $200.00 > 100% > 100% > 100% 42% 14% 8% 4% 3% 1% 60% - 70% 50% - 60% 50% - 60% 40% - 50% 75% - 90%

Table IX: Cost of an EMG under Private Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford an EMG


Country

Cost of Lumbar

Puncture in Private

Sector (Current

USD)

1st Income Decile

2nd Income Decile

3rd Income Decile

4th Income Decile

5th Income Decile

6th Income Decile

7th Income Decile

8th Income Decile

9th Income Decile

Below 100% of

Disposable Income


(40% Disposable

Income)

Below 20% of

Disposable Income

Below 10% of

Disposable Income

Doctor's Estimate

of % That Can

Afford

Bangladesh $64.02 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 50% - 75%

Botswana $3.57 > 100% > 100% 1% 0% 0% 0% 0% 0% 0% 70% - 80% 70% - 80% 70% - 80% 70% - 80% 75% - 90%

Brazil $92.76 3% 2% 2% 1% 1% 1% 1% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Ethiopia $39.54 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 50% - 75%

Ghana $100.00 > 100% > 100% > 100% > 100% 95% 20% 10% 5% 3% 50% - 60% 40% - 50% 30% - 40% 20% - 30% 75% - 90%

India $17.07 > 100% > 100% > 100% > 100% > 100% > 100% 18% 3% 1% 30% - 40% 30% - 40% 30% - 40% 20% - 30% 50% - 75%

Iran $30.00 8% 3% 2% 1% 1% 1% 1% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 75% - 90%

Jamaica $400.00 > 100% 41% 23% 16% 12% 9% 6% 5% 3% 80% - 90% 70% - 80% 60% - 70% 30% - 40% 75% - 90%

Japan $6.00 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 25% - 50%

Jordan $220.00 77% 20% 12% 8% 6% 5% 4% 3% 2% 90% - 100% 80% - 90% 70% - 80% 60% - 70% 75% - 90%

Kuwait $881.58 3% 2% 2% 2% 1% 1% 1% 1% 1% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 0% - 25%

Mexico $650.00 76% 29% 18% 12% 9% 7% 5% 4% 2% 90% - 100% 80% - 90% 70% - 80% 50% - 60% 50% - 75%

Myanmar $16.07 > 100% > 100% > 100% > 100% > 100% > 100% > 100% 20% 2% 20% - 30% 20% - 30% 10% - 20% 10% - 20% 50% - 75%

Netherlands $300.00 1% 1% 1% 1% 1% 0% 0% 0% 0% 90% - 100% 90% - 100% 90% - 100% 90% - 100% 50% - 75%

Nigeria $30.00 > 100% > 100% > 100% 11% 4% 2% 1% 1% 0% 60% - 70% 60% - 70% 60% - 70% 50% - 60% 75% - 90%

Pakistan $20.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 75% - 90%

Panama $100.00 20% 5% 3% 2% 1% 1% 1% 1% 0% 90% - 100% 90% - 100% 80% - 90% 80% - 90% 75% - 90%

Peru $60.00 21% 5% 3% 2% 1% 1% 1% 1% 0% 90% - 100% 90% - 100% 80% - 90% 80% - 90% 50% - 75%

South Africa $25.00 > 100% > 100% > 100% 3% 1% 1% 0% 0% 0% 60% - 70% 60% - 70% 60% - 70% 60% - 70% 75% - 90%

Uganda $40.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 0% - 10% 0% - 10% 0% - 10% 0% - 10% 25% - 50%

Zimbabwe $200.00 > 100% > 100% > 100% > 100% > 100% > 100% > 100% > 100% 27% 10% - 20% 10% - 20% 0% - 10% 0% - 10% 75% - 90%

Table X: Cost of a Lumbar Puncture under Private Insurance as a Percentage of Annual Household Disposable Income by Income Decile and the Percent of the Total Population That Can Afford a Lumbar Puncture


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