Targeted measures to address the needs of poor and vulnerable groups in commercialized health systems—such as fee waivers or subsidies—have been put in place but have often proven ineffective in reducing out-of-pocket expenditures.152 Current cutbacks in public health expenditure threaten to increase the financial burden on households. Women's OPPs have been found to be systematically higher than men's in a number of countries, including Brazil, the Dominican Republic, Ecuador, Paraguay and Peru, not only because of gender-specific health needs but also due to the greater prevalence of chronic illness and some mental health conditions among women. Decisions on what health conditions are included can be heavily gender-biased.