Factors Associated with Out-of-Pocket Health Expenditure in Polish Regions

Out-of-pocket (OOP) payments are perceived as the most regressive means of health financing. Using the panel-data approach and region-aggregated data from Statistics Poland, this research investigated associations between socio-economic factors and OOP health spending in 16 Polish regions for the period 1999–2019. The dependent variable was real (inflation-adjusted) monthly OOP health expenditure per person in Polish households. Potential independent variables included economic, labour, demographic, educational, health, environmental, and lifestyle measures based on previous research. A set of panel-data estimators was used in regression models. The factors that were positively associated with OOP health spending were disposable income, the proportions of children (aged 0–9) and elderly (70+ years) in the population, healthcare supply (proxied by physicians’ density), air pollution, and tobacco and alcohol expenditure. On the other hand, the increased unemployment rate, life expectancy at age 65, mortality rate, and higher sports participation were all related to lower OOP health spending. The results may guide national strategies to improve health-care allocations and offer additional financial protection for vulnerable groups, such as households with children and elderly members.

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Interpretation of China’s 2017 health expenditure: a latent profile analysis of panel data

BMJ Open ◽

10.1136/bmjopen-2019-035512 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035512

Author(s):

Shuang Zang ◽

Meizhen Zhao ◽

Jing OuYang ◽

Xin Wang

Keyword(s):

Panel Data ◽

Health Expenditure ◽

Latent Profile Analysis ◽

Profile Analysis ◽

Mainland China ◽

Health Financing ◽

Socioeconomic Indicators ◽

Macroeconomic Factors ◽

Per Capita ◽

Latent Profile

ObjectiveTo explore the latent structure of health financing and the institutional distribution of health expenditure (focused on hospital expenditure) in provinces, autonomous regions and municipalities of mainland China, and to examine how these profiles may be related to their externalising and internalising characteristics.Study designThe study used panel data harvested from the China National Health Accounts Report 2018.MethodsMainland China’s provincial data on health expenditure in 2017 was studied. A latent profile analysis was conducted to identify health financing and hospital health expenditure profiles in China. Additionally, rank-sum tests were used to understand the difference of socioeconomic indicators between subgroups.ResultsA best-fitting three-profile solution for per capita health financing was identified, with government health expenditure (χ2=10.137, p=0.006) and social health expenditure (χ2=6.899, p=0.032) varying significantly by profiles. Health expenditure in hospitals was subject to a two-profile solution with health expenditure flow to urban hospitals, county hospitals and community health service centres having significant differences between the two profiles (p<0.001).ConclusionsPer capita health financing and health expenditure spent in hospitals have discrepant socioeconomic characteristics in different profiles, which may be attributed to macroeconomic factors and government policies. The study provided new and explicit ideas for health financing and health policy regulation in China.

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Health Expenditure

Health Economics and Healthcare Reform ◽

10.4018/978-1-5225-3168-5.ch016 ◽

2018 ◽

pp. 268-292

Author(s):

Jesus Salgado-Vega ◽

Fatima Y. Salgado-Naime

Keyword(s):

Latin American ◽

Health Expenditure ◽

Health Spending ◽

Health Financing ◽

Government Health ◽

Long Run ◽

Out Of Pocket Payments ◽

Short Run ◽

Government Health Expenditure ◽

Main Components

This chapter explores the factors associated with the growth of total health expenditure, in addition to its main components, government health expenditure and out-of-pocket payments. Results suggest that health expenditure in general does not grow faster than gross national product (GNP). No difference is found in health expenditure between tax-based and insurance-based health financing mechanisms. The authors confirm the existence of fungibility, where external aid for health reduces government health spending and out-of-pocket payments from domestic sources. The study also finds that government health expenditure and out-of-pocket payments follow the same paths in time, but are different for countries at different levels of economic development and the same for health expenditure growth. In Latin American countries, the relationship between health expenditure and GNP per capita is positive; there is a quick adjustment in the short run to obtain long-run behavior.

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Health Expenditure

International Journal of Privacy and Health Information Management ◽

10.4018/ijphim.2015070102 ◽

2015 ◽

Vol 3 (2) ◽

pp. 27-50

Author(s):

Jesus Salgado-Vega ◽

Fatima Y. Salgado-Naime

Keyword(s):

Latin American ◽

Health Expenditure ◽

Health Spending ◽

Health Financing ◽

Government Health ◽

Long Run ◽

Out Of Pocket Payments ◽

Short Run ◽

Government Health Expenditure ◽

Main Components

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The impact of macro-fiscal factors and private health insurance financing on public health expenditure: evidence from the OECD countries for the period 2000–2017

EuroMed Journal of Business ◽

10.1108/emjb-03-2020-0029 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Georgios Sfakianakis ◽

Nikolaos Grigorakis ◽

Georgios Galyfianakis ◽

Maria Katharaki

Keyword(s):

Public Health ◽

Health Insurance ◽

Panel Data ◽

Health Expenditure ◽

Private Health Insurance ◽

Health Financing ◽

Oecd Countries ◽

Public Health Expenditure ◽

Content Type ◽

The Impact

PurposeBecause of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by significantly reducing public health expenditure (PHE) for dealing with their fiscal pressure and sovereign-debt challenges. Against this backdrop, this study aims to examine the responsiveness of PHE to macro-fiscal determinants, demography, as well to private health insurance (PHI) financing.Design/methodology/approachThe authors gather annual panel data from four international organizations databases for the total of OECD countries from a period lasting from 2000 to 2017. The authors apply static and dynamic econometric methodology to deal with panel data and assess the impact of several parameters on PHE.FindingsThe authors’ findings indicate that gross domestic product, fiscal capacity, tax revenues and population aging have a positive effect on PHE. Further, the authors find that both unemployment rate and voluntary private health insurance financing present a negative statistically significant impact on our estimated outcome variable. Different specifications and sample periods applied in the regression models reveal how inseparably associated are PHE and OECD's economies compliance on macro-fiscal policies for offsetting public finances derailment.Practical implicationsProviding more evidence on the responsiveness of PHE to several macro-fiscal drivers, it can be a helpful tool for governments to reconsider their persistence on fiscal adjustments measures and rank public health financing to the top of their political agenda. Health systems policies for meeting Universal Health Coverage (UHC) objectives, they should also take into consideration the voluntary PHI institution, especially for economies with insufficient fiscal capacity to raise public health financing.Originality/valueTo the best of knowledge, the impact of unemployment and voluntary PHI funding on public health financing, apart from other macro-fiscal and demographical parameters effect, remains unnoticed in the existing published studies on the topic.

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Faculty Opinions recommendation of Health expenditure and growth dynamics in the SADC region: evidence from non-stationary panel data with cross section dependence and unobserved heterogeneity.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733091645.793545175 ◽

2018 ◽

Author(s):

Venkatesh Seshamani

Keyword(s):

Panel Data ◽

Cross Section ◽

Health Expenditure ◽

Unobserved Heterogeneity ◽

Growth Dynamics ◽

Cross Section Dependence

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Health Expenditure and Economic Growth: A Worldwide Panel Data Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.2250761 ◽

2013 ◽

Cited By ~ 1

Author(s):

Miltiades N. Georgiou

Keyword(s):

Economic Growth ◽

Data Analysis ◽

Panel Data ◽

Health Expenditure ◽

Panel Data Analysis

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Strategies for reducing out of pocket payments in the health system: a scoping review

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-021-00301-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Faride Sadat Jalali ◽

Parisa Bikineh ◽

Sajad Delavari

Keyword(s):

Health System ◽

Health Systems ◽

Scoping Review ◽

Health Financing ◽

Developed Countries ◽

Vulnerable Groups ◽

System A ◽

Out Of Pocket Payments ◽

Review Study ◽

Developing And Developed Countries

Abstract Background Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.

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Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study

BMJ Open ◽

10.1136/bmjopen-2020-041870 ◽

2021 ◽

Vol 11 (2) ◽

pp. e041870

Author(s):

Tiara Marthias ◽

Kanya Anindya ◽

Nawi Ng ◽

Barbara McPake ◽

Rifat Atun ◽

...

Keyword(s):

Panel Data ◽

Health Service ◽

Low Income ◽

Health Expenditure ◽

Service Use ◽

Financial Burden ◽

Panel Data Analysis ◽

Productivity Loss ◽

Catastrophic Health Expenditure ◽

Health Service Use

ObjectivesTo examine non-communicable diseases (NCDs) multimorbidity level and its relation to households’ socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss.DesignThis study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5).SettingThe original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population.ParticipantsWe included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents.Primary outcome measuresWe examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables,ResultsWomen were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD.ConclusionsNCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidity in low-income and middle-income countries.

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