Socio-economic determinants of household out-of-pocket payments on healthcare in Pakistan

Community Health Sciences Department, Aga Khan University, Stadium Road, Karachi, 78400, Pakistan. .
International Journal for Equity in Health (Impact Factor: 1.71). 09/2012; 11(1):51. DOI: 10.1186/1475-9276-11-51
Source: PubMed


Out-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.
We 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.
Median 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.
Our 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.

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Available from: Ashar Muhammad Malik, Oct 01, 2015
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    • "The results of this study validate the existing literature, hence reinforcing the association between family income and socio-economic status of the household with the choice of health care provider to be consulted. OOP payments were incurred by a large proportion of the study population, similar to national data [21,31]. In our study area, significant number of population lives just above the poverty line. "
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