HEFPA is a collaborative research project funded by the European Commission’s 7th Framework Programme. It is part of the Special International Cooperation Actions (SICA) for Health Systems Research of the FP7 Health Theme. It is coordinated by Professor Eddy van Doorslaer of Erasmus University Rotterdam and involves researchers from six institutions in Asia and five in Europe. The World Bank is also a participant. The project runs for four years, from June 2009.


In low income Asia, as in other parts of the developing world, millions of people go without health care interventions that would be effective in preventing or treating disease. The poor are most deprived of effective treatments. In part, these deficiencies in access derive from the lack of affordability of health care, which is still principally financed from direct out-of-pocket (OOP) payments. Lack of health insurance cover not only constrains access to health care, with subsequent costs for population health and the economy through reduced productivity, it also leaves households exposed to the risk of medical expenses that can easily be large relative to modest incomes. Besides the threat to living standards posed by catastrophic medical expenditures, households may be pushed into poverty or driven into more severe poverty by OOP payments for health care.

Although adequate health insurance coverage is woefully lacking throughout much of low income Asia, leading to substantial gaps in access and financial risk protection, cover is being extended in a number of countries at varying speeds and through a variety of financing instruments. HEFPA uses the developments ocurring in health financing in seven countries of East and South-East Asia—Cambodia, China, Indonesia, Laos, the Philippines, Thailand and Vietnam— to learn about both the feasibility of extending health insurance coverage to poor populations and its impact on access to health care and on protection from the financial risks associated with illness.

Aims and Objectives

The project’s first aim is to determine the causes and the consequences of limited access, equity and affordability of health care in resource-poor Asian systems. Strand 1 of the project tackles this aim through descriptive, cross-country comparative research. The projects’ second goal is to identify potential solutions to problems of limited access and affordability of health care by drawing on the experience of the health financing reforms and innovations being implemented in the seven countries listed above. This evaluative, country-specific research forms Strand 2 of the project.