Community Health Sciences Department, Aga Khan University, Pakistan.
Int J Equity Health. 2012 Sep 4;11:51. doi: 10.1186/1475-9276-11-51.
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.
在发展中国家，医疗保健的自付费用（OOP）是主要的融资方式。在巴基斯坦，它占医疗保健总支出的 67%。分析 OOP 卫生支出的决定因素是医疗保健融资公平性的关键方面。它有助于制定有效的卫生政策。关于巴基斯坦 OOP 的证据很少。本文试图填补这一研究空白。
我们估计了巴基斯坦 OOP 医疗支出的决定因素。我们使用了 2004-05 年巴基斯坦家庭综合经济调查（HIES）和巴基斯坦生活水平测量（PSLM）调查的数据组。我们使用普通最小二乘法（OLS）方法为 OOP 支付的决定因素开发了一个多元回归模型。我们主要在分析中使用社会、经济、人口和健康变量。
2004-05 年，中位数家庭 OOP 医疗保健支出为 2500 巴基斯坦卢比（2004-05 年为 41.99 美元）。家庭非食品支出是家庭 OOP 健康支出的单一最高显著预测因素。家庭特征，如识字的户主和配偶、过去三年至少有一次分娩、不安全的水、不卫生的厕所和属于开伯尔-普赫图赫瓦省（KPK）的家庭，是 OOP 支付的显著正预测因素。户主为男性、房屋建筑用砖、至少有一个孩子和没有老年人的家庭以及从事白领职业的户主是 OOP 支付的负预测因素。
我们的分析证实了先前的发现，即经济状况和老年人口数量是 OOP 支付的显著正预测因素。这一关联可以引导政府增加对医疗保健的拨款，并纳入针对非传染性疾病的方案。我们的研究结果表明，需要进一步研究以探索政府医疗保健计划的受益者以及居住在 KPK 省的家庭 OOP 支付较高的决定因素，而不是其他省份。白领职业及其经济状况在预测 OOP 支付方面的相互作用也是一个进一步研究的领域。
