Medical spending and health outcome in Nepal: problems with technology or its distribution?

Notwithstanding the great improvements in medical technology such as oral rehydration therapy diarrhoea is still one of the leading causes of childhood morbidity and mortality in Nepal. Although easy-to-implement medical technologies help to reduce the health burden of many diseases the experience in Nepal indicates that how a health system works in terms of fair distribution of such technologies and financing perhaps matters most. Childhood mortality in many developing countries remains higher among poorer people and the gap between rich and poor has grown which indicates not only the uneven distribution of the benefits of improved medical technologies but also the extent of the economic consequences for households in the event of childhood illness. We argue that unless a national health system addresses distributional problems the benefits of medical technologies can never be realized fully. To justify our argument we present a small part of the results obtained from our analysis of the 1996 data of the Nepal Living Standard Survey. The design and implementation of the survey are described elsewhere. (excerpt)