Inequality In Health Expenditure Research Articles

Trends in out-of-pocket health expenditure inequality in Turkey under comprehensive health reforms

The success of Turkey's inclusive health policies has served as a strategic tool for building progressivity and improving social welfare. The objective of this study is to examine the inequality trend in out of pocket (OOP) health expenditures in Turkey. Data from the Turkish Statistical Institute's Household Budget Survey conducted in 2015 and 2019 were used to measure inequalities in OOP total health, pharmaceutical and hospital expenditure variables across socioeconomic status. Decomposition analysis was conducted to identify the factors contributing to inequalities. The study findings demonstrate that OOP health expenditure is higher among the poor in Turkey. Evidence suggests that in Turkey inequalities in OOP health expenditures continue to persist. The results show that OOP health, pharmaceutical, and hospital expenditures increased from 2015 to 2019. The inequality index and curve approaches reveal that the pro-rich distribution of OOP health expenditures is remarkable from 2015 to 2019. The burden of OOP pharmaceutical and hospital services expenditures stands on the shoulders of poor households. Progressive universalism is essential to achieve poverty alleviation strategies and reduce inequality for egalitarian development.

The Crowding-out Effect of Tobacco Expenditure on Health Expenditure: Evidence From a Lower-Middle-Income Country.

Poor people have remarkably lower health expenditures than rich people in Vietnam. According to the 2016 Vietnam Household Living Standard Survey (VHLSS), per capita health expenditure of the top quintile households is around 6 times higher than that of the bottom quintile households. We analyze economic inequalities in health expenditure using the concentration index approach and data from the VHLSS 2010-2016. Next, we use the instrumental-variable regression analysis to examine the crowding-out effect of tobacco expenditure on health expenditure. Finally, we use decomposition analysis to explore whether economic inequality in tobacco expenditure is associated with an economic inequality in health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of households. The share of health expenditure of households with tobacco spending is 0.78% lower than that of households without tobacco spending. It is estimated that a one-VND increase in tobacco expenditure results in a 0.18 Vietnamese Dong (VND) (95% CI: -0.30 to -0.06) decrease in health expenditure. There is a negative association between economic inequality in tobacco expenditure and economic inequality in health expenditure. This means that if the poor consume less tobacco, their expenditure on health can be increased, resulting in a decrease in inequality in health expenditure. Findings from this study suggest that reducing tobacco expenditure could improve health care of the poor and reduce inequality in health care in Vietnam. Our study recommends that the government continuously increase the tobacco tax in order to effectively reduce tobacco consumption. Empirical studies show mixed results on the effect of tobacco expenditure on health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of poor households in Vietnam. It implies that if the poor reduce their expenditure on tobacco, economic inequality in health expenditure can be reduced. Our findings suggest that reducing tobacco consumption in poor households can increase their health expenditure, therefore, decreasing inequality in health expenditure. Different policies to reduce tobacco consumption such as tobacco taxation, smoke-free areas, and tobacco advertisement bans should be strengthened.

Estimating the Income Elasticities of Health Expenditures for Income Quintiles and Inequality of Health Expenditures Distribution

Background: Determining the income elasticities of the household health expenditures, especially for income deciles, leads to adoption of appropriate policies to control and manage health expenditures among income deciles. Therefore, the main purpose of this study was to estimate the income elasticities of urban household health expenditures by income quintiles, and also calculate inequality in distribution of urban household health expenditures in Iran.
 Methods: This was a descriptive-analytical and applied study performed cross-sectionally with the Hackman two-stage method in Stata 16 software in 2021. The sample included 16,943 urban households in Statistics Center of Iran, and the data was extracted from the raw data of different sections of the cost and income questionnaire regarding urban households. Health expenditure inequality was measured by Gini coefficient, Robin Hood and Herfindal-Hershman indices.
 Results: The results showed that the income elasticity of health expenditures was 0.31 for the entire sample and 0.28, 0.66 and 0.36 for the first, second and fifth quintiles, respectively. The Gini, Robin Hood and Herfindal Hirschman indices were 0.240, 0.272 and 0.231, respectively. The increase in parents' educational level and household income, and having a child under seven and a private home had a positive effect and maternal employment had a negative effect on the increase of household health expenditures.
 Conclusion: Health is an important asset for urban households and the income quintiles; therefore, the adoption of redistributive policies is recommended to support households, especially the ones in the 2 lowest quintiles. The results of inequality indicators demonstrate the existence of inequality in the distribution of health expenditures; so, it is recommended to upgrade health insurance programs for low-income deciles, expand the coverage of essential medical services and receive premiums based on their ability to pay.

The impact of Medicare part D on income-related inequality in pharmaceutical expenditure

BackgroundIncome-related inequality measures such as the concentration index are often used to describe the unequal distribution of health, health care access, or expenditure in a single measure. This study demonstrates the use of such measures to evaluate the distributional impact of changes in health insurance coverage. We use the example of Medicare Part D in the United States, which increased access to prescription medications for Medicare beneficiaries from 2006.MethodsUsing pooled cross-sectional samples from the Medical Expenditure Panel Survey for 1997–2011, we estimated income-related inequality in drug expenditures over time using the concentration and generalised concentration indices. A difference-in-differences analysis investigated the change in inequality in drug expenditures, as measured using the concentration index and generalised concentration index, between the elderly (over 65 years) and near-elderly (54–63 years) pre- and post-implementation of Medicare Part D.ResultsMedicare Part D increased public drug expenditure while out-of-pocket and private spending fell. Public drug expenditures favoured the poor during all study periods, but the degree of pro-poorness declined in the years immediately following the implementation of Part D, with the poor gaining less than the rich in both relative and absolute terms. Part D also appeared to result in a fall in the pro-richness of private insurance drug expenditure in absolute terms but have minimal distributional impact on out-of-pocket expenditure. These effects appeared to be short lived, with a return to the prevailing trends in both concentration and generalised concentration indices several years following the start of Part D.ConclusionsThe implementation of Medicare Part D significantly reduced the degree of pro-poorness in public drug expenditure. The poor gained less of the increased public drug expenditure than the rich in both relative and absolute terms. This study demonstrates how income-related inequality measures can be used to estimate the impact of health system changes on inequalities in health expenditure and provides a guide for future evaluations.

Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

BackgroundIn the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state of Kerala and provides evidence on the consequent financial burden inflicted upon households in different caste groups.MethodsUsing data from a 2003-2004 panel survey in Kottathara Panchayat that collected detailed information on health care consumption from 543 households, we analysed inequality in per capita out-of-pocket health expenditure across castes by considering households' health care needs and types of care utilised. We used multivariate regression to measure the caste-based inequality in health expenditure. To assess health expenditure burden, we analysed households incurring high health expenses and their sources of finance for meeting health expenses.ResultsThe per capita health expenditures reported by four caste groups accord with their status in the caste hierarchy. This was confirmed by multivariate analysis after controlling for health care needs and influential confounders. Households with high health care needs are more disadvantaged in terms of spending on health care. Households with high health care needs are generally at higher risk of spending heavily on health care. Hospitalisation expenditure was found to have the most impoverishing impacts, especially on backward caste households.ConclusionCaste-based inequality in household health expenditure reflects unequal access to quality health care by different caste groups. Households with high health care needs and chronic health care needs are most affected by this inequality. Households in the most marginalised castes and with high health care need require protection against impoverishing health expenditures. Special emphasis must be given to funding hospitalisation, as this expenditure puts households most at risk in terms of mobilising monetary resources. However, designing protection instruments requires deeper understanding of how the uncovered financial burden of out-patient and hospitalisation expenditure creates negative consequences and of the relative magnitude of this burden on households.