Impoverishment from out-of-pocket health spending in Peruvian households, 2015-2020
DOI:
https://doi.org/10.35622/j.rg.2024.03.001Keywords:
COVID-19, determinants, impoverishment, out-of-pocket spending, healthAbstract
Economic literature has shown that out-of-pocket healthcare spending is the most unequal and inefficient way to finance medical care. It harms household welfare; as it increases family expenses and decreases consumption of basic goods like food. In situations of health "shock", these further aggravate and impoverish households. This study analyzes the impoverishment due to out-of-pocket healthcare spending in Peruvian households during the period 2015-2020. It followed the methodology of the World Health Organization and used the logit model to estimate the determining factors of such impoverishment. The results show that out-of-pocket health spending impoverished, on average, 2.6% of non-poor households, with greater impoverishment during the COVID-19 pandemic in 2020, at 3.53%. It was found that the factors determining impoverishment due to health spending were per capita household income, schooling, presence of chronic discomfort, disability of a household member, unmet basic needs such as inadequate housing, overcrowding and lack of sanitary facilities, low school attendance, and high economic dependency, health insurance. Finally, it was found that non-poor urban households become impoverished to a greater extent compared to rural households.
References
Akazili, J., Ataguba, J. E. O., Kanmiki, E. W., Gyapong, J., Sankoh, O., Oduro, A., & McIntyre, D. (2017). Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana. BMC International Health and Human Rights, 17(1). https://doi.org/10.1186/s12914-017-0121-7
Alvi, Y., Faizi, N., Khalique, N., & Ahmad, A. (2020). Assessment of out-of-pocket and catastrophic expenses incurred by patients with Human Immunodeficiency Virus (HIV) in availing free antiretroviral therapy services in India. Public Health, 183, 16–22. https://doi.org/10.1016/j.puhe.2020.03.031
Correa-Burrows, P. (2012). Out-Of-Pocket Health Care Spending by the Chronically Ill in Chile. Procedia Economics and Finance, 1, 88–97. https://doi.org/10.1016/s2212-5671(12)00012-3
Das, S., Sundaramoorthy, L., & Bhatnagar, T. (2020). Out-of-pocket expenditure for delivery at home and public health facilities in the context of conditional cash transfer and free delivery care programs: An analytical cross-sectional study in South 24 Parganas district, West Bengal, India, 2017. Clinical Epidemiology and Global Health, 8(4), 1395–1401. https://doi.org/10.1016/j.cegh.2020.06.007
Ebaidalla, E. M., & Mohammed, E. M. A. (2017). Determinants and Impact of Households’s Out-of-Pocket Health Care Expenditure in Sudan: Evidence From Urban and Rural Population. In Working Papers (1170). Economic Research Forum.
Garg, C. C., & Karan, A. K. (2009). Reducing out-of-pocket expenditures to reduce poverty: A disaggregated analysis at rural-urban and state level in India. Health Policy and Planning, 24(2), 116–128. https://doi.org/10.1093/heapol/czn046
Hooda, S. K. (2017). Out-of-pocket Payments for Healthcare in India. Journal of Health Management, 19(1), 1–15. https://doi.org/10.1177/0972063416682535
Keane, M., & Thakur, R. (2018). Health care spending and hidden poverty in India. Research in Economics, 72(4), 435–451. https://doi.org/10.1016/j.rie.2018.08.002
Ku, Y. C., Chou, Y. J., Lee, M. C., & Pu, C. (2019). Effects of National Health Insurance on household out-of-pocket expenditure structure. Social Science and Medicine, 222, 1–10. https://doi.org/10.1016/j.socscimed.2018.12.010
Lavilla, H. (2012). Empobrecimiento por Gasto de Bolsillo en Salud Informe Final. Consorcio de Investigación Económica y Social (CIES), 1–84.
Maddala, G. S. (1983). Limited-Dependent an Qualitative Variables in Economics. Cambridge University Press, 257–291.
Mamani, J. W. (2019). Análisis de los principales determinantes de la incidencia de gasto catastrófico de bolsillo en salud para los hogares del Perú y Puno – 2017. [Tesis de grado, Universidad Nacional del Altiplano]. http://repositorio.unap.edu.pe/handle/20.500.14082/10502
O’Donnell, O., van Doorslaer, E., Wagstaff, A., & Lindelow, M. (2008). Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation. In Analyzing Health Equity Using Household Survey Data. The World Bank. https://doi.org/10.1596/978-0-8213-6933-3
Organización Mundial de la Salud. (2019, February 20). Los países están gastando más en salud, pero las personas siguen pagando demasiado de sus bolsillos. https://cutt.ly/pegbak6e
Petrera, M., & Jiménez, E. (2018). Determinantes del gasto de bolsillo en salud de la población pobre atendida en servicios de salud públicos en Perú, 2010–2014. Rev Panam Salud Publica, 42, 1–7. https://doi.org/10.26633/RPSP.2018.20
Van, E. (2007). Paying Out-of-Pocket for Health Care in Asia: Catastrophic and Poverty Impact (Working Paper 2).
Wagner, N., Quimbo, S., Shimkhada, R., & Peabody, J. (2018). Does health insurance coverage or improved quality protect better against out-of-pocket payments? Experimental evidence from the Philippines. Social Science and Medicine, 204, 51–58. https://doi.org/10.1016/j.socscimed.2018.03.024
Wagstaff, A., Bilger, M., Sajaia, Z., & Lokshin, M. (2011). Health Equity and Financial Protection: Streamlined Analysis with ADePT Software. World Bank Publications.
Woldemichael, A., Gurara, D. Z., & Shimeles, A. (2016). Community-Based Health Insurance and Out-of-Pocket Healthcare Spending in Africa: Evidence from Rwanda. IZA Discussion Papers.
Wooldridge, J. M. (2002). Econometric Analysis of Cross Section and Panel Data. https://cutt.ly/HegbavTx
World Health Organization. (2005). Distribution of health payments and catastrophic expenditures Methodology. https://www.who.int/publications/i/item/EIP-FER-DP.05.2
Yap, A., Cheung, M., Kakembo, N., Kisa, P., Muzira, A., Sekabira, J., & Ozgediz, D. (2018). From procedure to poverty: out-of-pocket and catastrophic expenditure for pediatric surgery in Uganda. Journal of Surgical Research, 232, 484–491. https://doi.org/10.1016/j.jss.2018.05.077
Published
Issue
Section
License
Copyright (c) 2024 Henry Sucari (Autor/a)

This work is licensed under a Creative Commons Attribution 4.0 International License.
LOS AUTORES RETIENEN SUS DERECHOS:
- Los autores retienen sus derechos de marca y patente, y tambien sobre cualquier proceso o procedimiento descrito en el artículo.
- Los autores retienen el derecho de compartir, copiar, distribuir, ejecutar y comunicar públicamente el artículo publicado en Gestionar: revista de empresa y gobierno (por ejemplo, colocarlo en un repositorio institucional o publicarlo en un libro), con un reconocimiento de su publicación inicial.
- Los autores retienen el derecho a hacer una posterior publicación de su trabajo, de utilizar el artículo o cualquier parte de aquel (por ejemplo: una compilación de sus trabajos, notas para conferencias, tesis, o para un libro), siempre que indiquen la fuente de publicación (autores del trabajo, revista, volumen, número y fecha).















