Progressivity of out-of-pocket payments and its determinants decomposed over time

Koch, Steven F.; Setshegetso, Naomi

doi:10.1080/0376835x.2021.1880373

Cited by 3 publications

(2 citation statements)

References 39 publications

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“…The exploratory variables (covariates) are informed by Andersen’s Health Behaviour model, distinguishing the following three categories of factors affecting access to healthcare services [ 22 ]: (i) enabling factors , including gender, age group, and marital status; (ii) predisposing factors , including educational level, economic status, employment status, and health insurance coverage status; and (ii) need factors , including periodic check-ups and self-rated health. In addition, these socioeconomic factors are based on evidence from previous studies that demonstrated their relative influence on OOP health expenditure [ 23 – 25 ].…”

Section: Methodsmentioning

confidence: 99%

Assessing the inequality in out-of-pocket health expenditure among the chronically and non-chronically ill in Saudi Arabia: a Blinder-Oaxaca decomposition analysis

Al-Hanawi

Njagi

2022

Int J Equity Health

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Background Many high-income countries have made significant progress towards achieving universal health coverage. Nevertheless, out-of-pocket (OOP) health expenditure continues to undermine the effectiveness of the universal healthcare system. In Saudi Arabia, due to the overburdened free public health services, many people opt for alternative healthcare services, risking high OOP payments. The presence of chronic illness further exacerbates this situation. However, there is limited evidence on the extent of the gap in OOP health expenditure between the chronically and non-chronically ill and the associated drivers contributing to this gap. The aim of this study was to assess inequalities in relative OOP health expenditure, estimated as the percentage of income spent on healthcare, between the chronically and non-chronically ill in Saudi Arabia and their associated drivers. Methods Data from 10,785 respondents were obtained from a national cross-sectional survey conducted in Saudi Arabia as part of the 2018 Family Health Survey. Inequalities in relative OOP health expenditure were measured using concentration indices and curves. A Blinder-Oaxaca decomposition analysis was used to assess the differences in relative OOP health expenditure between the chronically and non-chronically ill. Results The results showed that the chronically ill experience a higher financial burden due to healthcare services in absolute costs and relative to their income compared to the non-chronically ill. In addition, there was higher pro-poor inequality (–0.1985) in relative OOP health expenditure among the chronically ill compared to that (–0.1195) among the non-chronically ill. There was a 2.6% gap in relative OOP health expenditure among the chronically and non-chronically ill, of which 53.8% was attributable to unexplained factors, with explained factors accounting for the 46.2% difference. Factors that significantly contributed to the overall gap (i.e. both explained and non-explained factors) included employment status, insurance status, self-rated health, and periodic check-ups. Conclusion This study underscores the high financial burden due to OOP payments among the chronically ill and the existence of pro-poor inequalities. In addition, there is a significant gap in relative OOP health expenditure between the chronically and non-chronically ill, which is mainly attributable to differences in socio-economic characteristics. This indicates that the existing financial mechanisms have not been sufficient in cushioning the chronically ill and less well off in Saudi Arabia. This situation calls for health policymakers to integrate a social safety net into the health financing system and to prioritize the disadvantaged population, thereby ensuring access to health services without experiencing financial hardship.

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Section: Methodsmentioning

confidence: 99%

Assessing the inequality in out-of-pocket health expenditure among the chronically and non-chronically ill in Saudi Arabia: a Blinder-Oaxaca decomposition analysis

Al-Hanawi

Njagi

2022

Int J Equity Health

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“…Equivalence scales also underpin means‐tests for government transfers, tax policy—especially exemptions for dependents—and subsidy policy, such as those that might focus on support for young children. Equivalence scales are also used in the estimation of catastrophic health expenditures (Ataguba, 2012; Koch & Setshegetso, 2020, 2021), although Koch (2018) suggests that the choice of scale does not make much difference in the underlying estimation of catastrophe, when following the World Health Organization method (Xu, 2005). Ye and Koch (2021) and Ye et al (2019) adopt the concept to determine household energy requirements and measure energy poverty.…”

Section: Introductionmentioning

confidence: 99%

Equivalence scales in a developing country with extensive inequality

Koch

2022

South African J Economics

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This study estimates food budget share equations to calculate household equivalence scales that incorporate base‐independence and address potential endogeneity, even though an instrument that satisfies the usual exclusion restriction may not be available. The application incorporates semi‐parametric methods, control functions and heteroscedasticity instrumentation, allowing for heterogeneity in household preferences. The application is founded on the most recent income and expenditure data that are available for South Africa. We find that there is extensive heterogeneity and that endogeneity matters. Failing to account for endogeneity leads to overstated equivalence scales in nearly every circumstance. When we fit our calculated scales to a typical ()false(A+κKfalse)ψ equivalence structure via non‐linear least squares, we find values of ()κ near unity and values of ()ψ mostly below 0.5. Thus, our analysis suggests that a square‐root scale is more appropriate than other scales that have been used to examine poverty and inequality in South Africa.

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Progressivity of out-of-pocket payments and its determinants decomposed over time

Koch

Setshegetso

2021

Development Southern Africa

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This study estimates progressivity of out-of-pocket (OOP) health payments and their determinants using South African Income and Expenditure Surveys. Concentration is decomposed to examine the effect of household determinants on OOP inequality, shedding light on how progressivity/regressivity is related to changes in the concentration and elasticities of the determinants over time. Our results suggest that actual OOP health expenditures are concentrated among non-poor households, although less so now than in the recent past. When OOP health payments are viewed from the perspective of affordability, which instead focuses on the share of payments relative to capacity-to-pay, they are regressive; However, they have become less concentrated amongst poor households, although still regressive, recently. These results appear to be independent of the measure of socioeconomic status employed in the analysis. The results highlight large income and education related disparities and also suggest continued gender and ethnic differences that deserve further attention in policymaking.

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Progressivity of out-of-pocket payments and its determinants decomposed over time

Cited by 3 publications

References 39 publications

Assessing the inequality in out-of-pocket health expenditure among the chronically and non-chronically ill in Saudi Arabia: a Blinder-Oaxaca decomposition analysis

Assessing the inequality in out-of-pocket health expenditure among the chronically and non-chronically ill in Saudi Arabia: a Blinder-Oaxaca decomposition analysis

Equivalence scales in a developing country with extensive inequality

Progressivity of out-of-pocket payments and its determinants decomposed over time

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