Abstract
BackgroundOut-of-pocket (OOP) payment on healthcare is dominant mode of financing in developing countries. In Pakistan it is 67% of total expenditure on healthcare. Analysis of determinants of OOP health expenditure is a key aspect of equity in healthcare financing. It helps to formulate an effective health policy. Evidence on OOP in Pakistan is sparse. This paper attempts to fill this research gap.MethodsWe estimated determinants of OOP payments on healthcare in Pakistan. We used data sets of Pakistan Household Integrated Economic Survey (HIES) and Pakistan Standard of Living Measurement (PSLM) Survey for the year 2004-05. We developed a multiple regression model for the determinants of OOP payments using methods of Ordinary Least Square (OLS). We mainly used social, economic, demographic and health variables in our analysis.ResultsMedian household OOP healthcare in the year 2004-05 was Pakistani Rupees (PKR) 2500 (US$ 41.99) in 2004-05. Household non-food expenditure was the single highest significant predictor of household OOP health expenditure. Household features like literate head and spouse, at least one obstetric delivery in last three years, unsafe water, unhygienic toilet and household belonging to Khyber Pukhtonkhwa (KPK) province were significant positive predictors of OOP payments. Households with male head, bricks used in housing construction, household with at least one child and no elderly, and head of household in a white collar profession were negative predictors of OOP payments.ConclusionOur analysis confirms earlier findings that economic status and number of old aged members are significant positive predictors of OOP payments. This association can direct government to enhance allocations to healthcare and to include program focusing on non-communicable diseases. Our findings suggest further research to explore beneficiaries of government healthcare programs and determinants of high OOP payments by household residing in KPK province than other province. The interaction between white collar profession and their economic status in predicting OOP payments is also an area for further research.
Highlights
Out-of-pocket (OOP) payment on healthcare is dominant mode of financing in developing countries
We found marked differences in household OOP payment related to their socio-economic characteristics
Our findings strengthen the argument that multiple factors influence OOP payments
Summary
Out-of-pocket (OOP) payment on healthcare is dominant mode of financing in developing countries. Analysis of determinants of OOP health expenditure is a key aspect of equity in healthcare financing. It helps to formulate an effective health policy. Households may borrow money, sell assets or divert resources from other needs to seek healthcare. One of the main objectives of national and international health policy is to replace OOP payments with more equitable modes of financing [5]. In this context analysis of determinants of OOP payments is important for devising an effective health policy. The behavioral model of health service-use emphasizes role of multiple factors in determining health services-use such as demography, social structure and health beliefs, availability of health services, financial resources and community support, perceived and actual need for healthcare and consumer satisfaction [8,9]
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