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1

Łyszczarz, Błażej, and Zhaleh Abdi. "Factors Associated with Out-of-Pocket Health Expenditure in Polish Regions." Healthcare 9, no. 12 (2021): 1750. http://dx.doi.org/10.3390/healthcare9121750.

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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
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Chisholm, Dan, Emily Garman, Erica Breuer, et al. "Health service costs and their association with functional impairment among adults receiving integrated mental health care in five low- and middle-income countries: the PRIME cohort study." Health Policy and Planning 35, no. 5 (2020): 567–76. http://dx.doi.org/10.1093/heapol/czz182.

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Abstract This study examines the level and distribution of service costs—and their association with functional impairment at baseline and over time—for persons with mental disorder receiving integrated primary mental health care. The study was conducted over a 12-month follow-up period in five low- and middle-income countries participating in the Programme for Improving Mental health carE study (Ethiopia, India, Nepal, South Africa and Uganda). Data were drawn from a multi-country intervention cohort study, made up of adults identified by primary care providers as having alcohol use disorders,
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Buitrago-Garcia, D., F. Rodriguez, G. Sánchez, and P. Santos-Moreno. "AB1340-HPR PATIENTS’ OUT-OF-POCKET EXPENSES ANALYSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS ENROLLED IN A EDUCATIONAL PROGRAM." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1958.2–1958. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5526.

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Background:The increasing health and economic burdens of deaths and disabilities from non-communicable diseases (NCDs) are emerging as major concerns worldwide, particularly for low- and middle-income countries (LMICs)(1). Rheumatoid arthritis (RA) NCD is considered as one of the most common causes of disability. RA affects from 0.5% to 1% of the worldwide population. Little is known about the out-of-pocket (OOP) expenditures for prescription of pharmacological treatment for patients with RA, including drugs, diagnostic tests, mobility aids among others.Objectives:To describe the out of pocket
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Ahmed, Sayem, Abdur Razzaque Sarker, Marufa Sultana, et al. "Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case–control study in Bangladesh." BMJ Open 10, no. 3 (2020): e030298. http://dx.doi.org/10.1136/bmjopen-2019-030298.

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ObjectiveWe estimated the effect of an employer-sponsored health insurance (ESHI) scheme on healthcare utilisation of medically trained providers and reduction of out-of-pocket (OOP) expenditure among ready-made garment (RMG) workers.DesignWe used a case–control study design with cross-sectional preintervention and postintervention surveys.SettingsThe study was conducted among workers of seven purposively selected RMG factories in Shafipur, Gazipur in Bangladesh.ParticipantsIn total, 1924 RMG workers (480 from the insured and 482 from the uninsured, in each period) were surveyed from insured a
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Obembe, Taiwo A., Jonathan Levin, and Sharon Fonn. "Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria." PLOS ONE 16, no. 8 (2021): e0255354. http://dx.doi.org/10.1371/journal.pone.0255354.

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Background Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria. Methods The study utilised a
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Wright, Kikelomo Ololade, Adeyinka Adeniran, Adedayo Aderibigbe, et al. "Factors associated with Catastrophic Healthcare Expenditure in communities of Lagos Nigeria: A Megacity experience." PLOS ONE 20, no. 1 (2025): e0316814. https://doi.org/10.1371/journal.pone.0316814.

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Background Each year, millions of people in low—and middle-income countries such as Nigeria are forced into poverty and financial ruin due to out-of-pocket (OOP) healthcare expenses. Our study assessed the prevalence and determinants of Catastrophic Healthcare Expenditure (CHE) experienced by households in Lagos, Nigeria. Methods A descriptive community-based cross-sectional survey was conducted on 2492 households in Lagos from December 2022 to March 2023 in 4 Local Government Areas (LGAs) using a multistage sampling technique. Data was collected using pre-tested semi-structured questionnaires
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Henrietta Ukpe, Udeme, and Sani Mohamadou. "Out-of-Pocket Health Expenditures and Agricultural Production Linkages." Health Economics and Management Review 5, no. 4 (2024): 147–56. https://doi.org/10.61093/hem.2024.4-10.

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Out-of-pocket (OOP) health expenditure is the amount a patient pays directly for healthcare when insurance doesn’t cover the full cost. OOP health expenditures represent a significant financial burden on households. In Cameroon where healthcare financing is heavily reliant on OOP payments, the economic impact of health-related expenses is especially pronounced, affecting various sectors, including agriculture, which is the backbone of the country’s economy. Examining the relationship between OOP health expenditures and agricultural production is essential. This study investigates the linkages
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Duan, Weixia, Wen Zhang, Chengguo Wu, et al. "Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study." BMJ Open 9, no. 4 (2019): e026638. http://dx.doi.org/10.1136/bmjopen-2018-026638.

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ObjectiveTo investigate the extent and associations of patient/diagnostic delay and other potential factors with catastrophic health expenditure (CHE) for tuberculosis (TB) care in Chongqing municipality, China.DesignA cross-sectional study.SettingFour counties of Chongqing municipality, China.ParticipantsA total of 1199 patients with active pulmonary TB beyond 16 years and without mental disorders were consecutively recruited in the four counties’ designated TB medical institutions.Outcome measuresThe incidence and intensity of CHE for TB care were described. The association between patients’
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Khan, Jinat Jahan, Farzana Sehrin, Zahidul Quayyum, Abdur Razzaque Sarker, and Mohammad Shafiqur Rahman. "Factors affecting out-of-pocket expenditures for chronic and acute illnesses in Bangladesh." PLOS ONE 20, no. 4 (2025): e0320429. https://doi.org/10.1371/journal.pone.0320429.

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Background In the absence of universal healthcare protection, out-of-pocket (OOP) expenditures are the main source of healthcare financing in Bangladesh. This study assesses the disparities in the overall and the components of OOP expenditures among households with both chronic and acute illnesses compared to those having acute illnesses only. It also identifies factors influencing OOP expenditures over time and examines patterns related to various illness conditions. Materials and methods Data from the Household Income and Expenditure Surveys (HIES) of 2016–17 and 2022 were used. A Log-linear
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Smith, Emily R., Pamela Espinoza, Madeline Metcalf, et al. "Modeling the global impact of reducing out-of-pocket costs for children’s surgical care." PLOS Global Public Health 4, no. 1 (2024): e0002872. http://dx.doi.org/10.1371/journal.pgph.0002872.

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Over 1.7 billion children lack access to surgical care, mostly in low- and middle-income countries (LMICs), with substantial risks of catastrophic health expenditures (CHE) and impoverishment. Increasing interest in reducing out-of-pocket (OOP) expenditures as a tool to reduce the rate of poverty is growing. However, the impact of reducing OOP expenditures on CHE remains poorly understood. The purpose of this study was to estimate the global impact of reducing OOP expenditures for pediatric surgical care on the risk of CHE within and between countries. Our goal was to estimate the impact of re
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Chevan, Julia, Daniel L. Riddle, and Shelby D. Reed. "Out-of-Pocket Spending for Ambulatory Physical Therapy Services From 2008 to 2012: National Panel Survey." Physical Therapy 95, no. 12 (2015): 1680–91. http://dx.doi.org/10.2522/ptj.20150018.

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Background Out-of-pocket (OOP) expenditures are incurred as insurers and employers shift some of the burden of health care costs onto consumers. As cost-sharing increases, OOP expenditures could be a barrier to physical therapy care. Objective The purposes of this study were: (1) to identify factors associated with any OOP physical therapy spending and (2) to identify factors associated with higher spending among individuals incurring OOP costs. Design The study was a retrospective analysis using the 4 most recently available panels of data from the Medical Expenditure Panel Survey (MEPS) enco
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Chai, Peipei, Yuhui Zhang, Maigeng Zhou, Shiwei Liu, and Yohannes Kinfu. "Health system productivity in China: a comparison of pre- and post-2009 healthcare reform." Health Policy and Planning 35, no. 3 (2019): 257–66. http://dx.doi.org/10.1093/heapol/czz157.

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Abstract In 2009, China launched an ambitious health system reform that combined extending social health insurance scheme with improving efficiency, access and quality of care in the country. To assess the impact of the policy on efficiency and productivity change, we investigated the country’s health system performance at provincial levels during pre- and post-reform period. Outputs were measured using multiple health outcomes (namely, non-communicable diseases free healthy life years and infant and maternal survival rates), while health expenditure, number of medical personnel and hospital b
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Villanueva, Winnie Mae DJ, and Peter John B. Aranas. "Catastrophic Out-of-Pocket Expenditure on Health: Evidence from the Regions in the Philippines." Journal Healthcare Treatment Development, no. 36 (September 23, 2023): 18–28. http://dx.doi.org/10.55529/jhtd.36.18.28.

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This study estimates Filipino’s catastrophic and impoverishing out-of-pocket (OOP) healthcare expenditures on a regional perspective to measure the effectiveness and progress of Philippines’ healthcare financing system in ensuring population protection from excessive and unequal healthcare costs. Observations are drawn from the most recent household-based survey in the Philippines, 2018 and 2021 Family Income and Expenditure Survey, and grouped by four major regions: National Capital Region, the rest of Luzon, Visayas, and Mindanao region. From 2018 to 2021, results showed that the distributio
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Weinberger, Michelle, Nicole Bellows, and John Stover. "Estimating private sector out-of-pocket expenditures on family planning commodities in low-and-middle-income countries." BMJ Global Health 6, no. 4 (2021): e004635. http://dx.doi.org/10.1136/bmjgh-2020-004635.

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IntroductionThe role of the private sector in family planning (FP) is well studied; however, few efforts have been made to quantify the role of private out-of-pocket (OOP) expenditures on FP commodities across low-and-middle-income countries (LMICs). Calculating OOP expenditures is important to illuminate the magnitude of these contributions and to inform discussions on how financial burdens can be reduced.MethodsEstimates of FP users and commodities consumed by women getting their FP methods from the private sector were made for 132 LMICs. Next, unit price data were compiled from to estimate
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Baharin, Mohamed Fakhri Abu, Muhamad Hanafiah Juni, and Rosliza Abdul Manaf. "Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia." International Journal of Environmental Research and Public Health 19, no. 8 (2022): 4500. http://dx.doi.org/10.3390/ijerph19084500.

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Background: Out-of-pocket (OOP) payments are an inequitable mechanism for health financing as their high share of total health expenditures poses a risk of catastrophic healthcare expenditures. This study aimed to assess the distribution and progressivity of OOP payments made by Malaysian households for various group of healthcare services. Methods: This study utilized data from the Malaysian Household Expenditure Survey (HES) between 2014 and 2015, which involved 14,473 households. Distribution and progressivity of OOP payments were measured through their proportion of household consumption,
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Avila, Jaqueline C., Sapna Kaul, and Rebeca Wong. "Health Care Expenditures and Utilization Among Older Mexican Adults." Journal of Aging and Health 32, no. 5-6 (2018): 269–77. http://dx.doi.org/10.1177/0898264318818901.

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Objectives: Examine differences in health care utilization and out-of-pocket (OOP) expenditures among older Mexican adults in 2001 and 2012, and identify individual characteristics associated with utilization and expenditures in both years. Method: Data from the 2001 and 2012 cross-sections of the Mexican Health and Aging Study were utilized. Outcomes included nights spent in the hospital, medical/outpatient procedures, and OOP expenditures with these services. Covariates included demographics and comorbidities. Two-part regression models were used to identify covariates associated with utiliz
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Senturk, Bilge, Aysun Danisman Isik, and Cisel Ekiz Gokmen. "Determinants of out of pocket healthcare expenditures: The case of Mugla province in Turkey." Global Journal of Business, Economics and Management: Current Issues 9, no. 2 (2019): 76–83. http://dx.doi.org/10.18844/gjbem.v9i2.4225.

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As the share of health care financing from public funds was increasing in Turkey, the utilization of the health care services has also increased, dramatically. Despite of universal health coverage, the result of this trend causes to increase the incidence of making out of pocket expenditures. The aim of this study is to evaluate the determinants of households’ health expenditures in Mugla province of Turkey. A total of 204 households living in the central district of Mugla were surveyed and questioned both for their total consumption and health expenditures, as well as their health status, dem
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Smith, Emily R., Pamela Espinoza, Happiness D. Kajoka, et al. "Impact of out-of-pocket expenses on children with cancer in Tanzania: A mixed-methods economic study." PLOS One 20, no. 6 (2025): e0326755. https://doi.org/10.1371/journal.pone.0326755.

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Background For children with cancer in low- and middle-income countries, medical and non-medical expenses are often paid through out-of-pocket (OOP) expenditures, which pose significant barriers to timely care. Our study aims to estimate the impact of OOP expenditures for cancer care for children in Tanzania through a mixed-methods approach. Methods We used an explanatory mixed-method design to evaluate the impact of OOP expenditures for children receiving cancer care at the Kilimanjaro Christian Medical Center in Tanzania based on the Three Delays Framework. Quantitative data were collected t
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Thanh, Nguyen Duc, Bui Thi My Anh, Chu Huyen Xiem, and Hoang Van Minh. "Out-of-Pocket Health Expenditures Among Insured and Uninsured Patients in Vietnam." Asia Pacific Journal of Public Health 31, no. 3 (2019): 210–18. http://dx.doi.org/10.1177/1010539519833549.

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Out-of-pocket expenditure/payment (OOP) is one of the indicators measuring the achievement of Universal Health Coverage. This article aimed to compare OOP among the insured and uninsured for their outpatient and inpatient health care services. The data of 6710 individuals using outpatient care and 924 individuals using inpatient care at 78 district hospitals and 246 commune health centers in 6 provinces from the World Bank survey, “The 2015 Vietnam District and Commune Health Facility,” were used for analysis. In the ordinary least square model, the estimated coefficient of the insurance statu
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Memirie, Solomon Tessema, Mizan Habtemichael, Hamelmal G. Hailegiorgis, et al. "Out-of-pocket expenditure and financial risks associated with treatment of chronic kidney disease in Ethiopia: a prospective cohort costing analysis." BMJ Global Health 10, no. 6 (2025): e019074. https://doi.org/10.1136/bmjgh-2025-019074.

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IntroductionIn Ethiopia, most healthcare expenditures are paid out-of-pocket (OOP), while the burden of kidney disease (KD) is rapidly increasing, posing a major public health challenge in low- and middle-income countries, along with a staggering economic burden. We aimed to quantify the extent of OOP health expenditures and the magnitude of associated catastrophic and impoverishing health expenditures (CHE and IHE) for chronic KD (CKD) care in Ethiopia.MethodsWe conducted a prospective costing analysis for CKD care from the patient perspective. We collected data on OOP health expenditures (20
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Memirie, Solomon Tessema, Mieraf Taddesse Tolla, Eva Rumpler, et al. "Out-of-pocket expenditures and financial risks associated with treatment of vaccine-preventable diseases in Ethiopia: A cross-sectional costing analysis." PLOS Medicine 20, no. 3 (2023): e1004198. http://dx.doi.org/10.1371/journal.pmed.1004198.

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Background Vaccine-preventable diseases (VPDs) remain major causes of morbidity and mortality in low- and middle-income countries (LMICs). Universal access to vaccination, besides improved health outcomes, would substantially reduce VPD-related out-of-pocket (OOP) expenditures and associated financial risks. This paper aims to estimate the extent of OOP expenditures and the magnitude of the associated catastrophic health expenditures (CHEs) for selected VPDs in Ethiopia. Methods and findings We conducted a cross-sectional costing analysis, from the household (patient) perspective, of care-seek
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Makika, Maya, Fred Matovu, Wasswa Matovu, and Mesele Araya. "Effect of Out-of-Pocket Health Expenditure on Household Welfare: Evidence from Uganda National Household Survey: 2016–2017." Tanzanian Economic Review 12, no. 1 (2022): 18–34. http://dx.doi.org/10.56279/ter.v12i1.94.

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Out-of-Pocket health expenditures (OOP) in Uganda are increasingly rising due to the limited share of the national budget allocation to the health sector. Using Uganda National Household Survey data (UNHS) 2016/17, this study investigates the effect of OOP health expenditures on household welfare in Uganda. Due to the presence of endogeneity, the study employs a robust sampling instrumental variable technique to control for simultaneous causality between household welfare and the OOP health expenditure variable in the model. The findings show that a unit increase in OOP health expenditure redu
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Smith, Emily R., Pranav Kapoor, Tessa Concepcion, et al. "Does reducing out-of-pocket costs for children’s surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study." BMJ Open 13, no. 5 (2023): e069572. http://dx.doi.org/10.1136/bmjopen-2022-069572.

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ObjectivesAn estimated 1.7 billion children around the world do not have access to safe, affordable and timely surgical care, with the financing through out-of-pocket (OOP) expenses being one of the main barriers to care. Our study modelled the impact of reducing OOP costs related to surgical care for children in Somaliland on the risk of catastrophic expenditures and impoverishment.Design and settingThis cross-sectional nationwide economic evaluation modelled several different approaches to reduction of paediatric OOP surgical costs in Somaliland.Participants and outcome measuresA surgical re
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Alrashed, Anwar, and Hany Ramadan Mohamed. "Patient out-of-pocket expenditure in primary care comparing high income, middle income and low-income countries." International journal of health sciences 8, S1 (2024): 1365–88. http://dx.doi.org/10.53730/ijhs.v8ns1.15241.

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Background: Out-of-pocket health expenditures (OOPHE) in primary care can pose a significant financial burden on individuals and households, particularly in low- and middle-income countries. Understanding the factors influencing OOPHE is crucial for developing effective policies to improve healthcare access and affordability. Objective: This systematic review aimed to identify and analyze the factors influencing OOPHE in primary care settings across high-, middle-, and low-income countries. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies. Incl
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Raval, Amit D., and Ami Vyas. "Trends in Healthcare Expenditures among Individuals with Arthritis in the United States from 2008 to 2014." Journal of Rheumatology 45, no. 5 (2018): 705–16. http://dx.doi.org/10.3899/jrheum.170368.

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Objective.With the expected rise in the arthritis population, information is required regarding trends of healthcare expenditures among individuals with arthritis in the United States. We examined temporal trends in direct and out-of-pocket (OOP) healthcare expenditures among individuals with arthritis using a nationally representative database, the Medical Expenditures Panel Survey.Methods.The study population was composed of cross-sectional cohorts of individuals aged ≥ 18 years from 2008 to 2014. Two-part models were used to estimate the incremental total and types of annual direct and OOP
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Sriram, Shyamkumar, and Muayad Albadrani. "Do hospitalizations push households into poverty in India: evidence from national data." F1000Research 13 (March 21, 2024): 205. http://dx.doi.org/10.12688/f1000research.145602.1.

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Introduction High percentage of OOP (Out-of-Pocket) costs can lead to poverty and exacerbate existing poverty, with 21.9% of India’s 1.324 billion people living below the poverty line. Factors such as increased patient cost-sharing, high-deductible health plans, and expensive medications contribute to high OOP costs. Understanding the poverty-inducing impact of healthcare payments is essential for formulating effective measures to alleviate it. Methods The study used data from the 75th round of the National Sample Survey Organization (Household Social Consumption in India: Health) from July 20
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Marlinda, Marlinda, and Vetty Yulianty Permanasari. "Pengeluaran out of pocket rumah tangga untuk upaya pencegahan kesehatan anak: analisis berbasis two part model dan Tobit." Berita Kedokteran Masyarakat 35, no. 1 (2019): 1. http://dx.doi.org/10.22146/bkm.42519.

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Out-of-pocket household expenditure for child health prevention services: two-part and tobit modelPurposeTo find out socio-economic determinants and the amount of out-of-pocket (OOP) for household expenditure in health prevention for children.MethodsThis study compared two approaches from several alternative assumptions including the two-part model and Tobit, which can be used when variable analysis has a problem selection. The dependent variable was household expenditure for children health prevention services in Indonesia, where the probability of dependent variable was affected by latent va
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Yusuf, Farhat, and Stephen Leeder. "Recent estimates of the out-of-pocket expenditure on health care in Australia." Australian Health Review 44, no. 3 (2020): 340. http://dx.doi.org/10.1071/ah18191.

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Objective The aims of this study were to estimate the average annual out-of-pocket (OOP) expenditure on health care by households in Australia in 2015–16, and to compare this with the estimate for 2009–10. Methods Data from the most recent Household Expenditure Survey (HES) conducted by the Australian Bureau of Statistics were used. Various statistical methods were used to estimate the annual OOP expenditures at the household and national levels. Results The average annual OOP expenditure was A$4290 per household, representing 5.8% of the amount spent on all goods and services. Private health
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Thakur, Kanchan, Raveen ., Sita ., et al. "Assessment of health problems and healthcare expenditure, utilization of healthcare schemes and insurances among residents of Dhanas UT Chandigarh." International Journal Of Community Medicine And Public Health 8, no. 5 (2021): 2279. http://dx.doi.org/10.18203/2394-6040.ijcmph20211746.

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Background: Non-communicable diseases account for high burden of morbidity and mortality all over the world. Increased burden and need of long-lasting medical care pose adverse financial implications on poor households. It becomes even more difficult in the absence of any financial risk protection (FRP). In that case the families are forced to manage health care expenditures from the money needed for their routine daily expenses thus increasing Out of pocket expenditures. Objective of the study was to assess the morbidity burden, and out of pocket (OOP) expenditure on healthcare; assess the ut
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Vezhnovets, Tatiana A., Vitalyi G. Gurianov, Natalia V. Prus, Oleksandr V. Korotkyi, and Olena Y. Antonyuk. "HEALTH CARE EXPENDITURES OF 179 COUNTRIES WITH DIFFERENT GNI PER CAPITA IN 2018." Wiadomości Lekarskie 74, no. 3 (2021): 678–83. http://dx.doi.org/10.36740/wlek202103221.

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The aim: To study the difference in health care expenditures in groups of countries with different GNI per capita. Materials and methods: In 4 groups of countries with different GNI per capita were analyzed indicators of Current health expenditure per capita ($) (СHE), Domestic general government health expenditure per capita, PPP ($) (GGHE $) and GGHE%, Domestic private health expenditure per capita, PPP ($) (PHE) and PHE%, Out-of-pocket expenditure (%) (OOP), Current health expenditure (% of GDP) (CHE% GDP). Results: The group of high-income countries differs by CHE, GGHE $, GGHE%, PHE $, PH
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Sarker, Abdur Razzaque, S. M. Zulfiqar Ali, Maruf Ahmed, S. M. Zahedul Islam Chowdhury, and Nausad Ali. "Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh." PLOS ONE 17, no. 1 (2022): e0262900. http://dx.doi.org/10.1371/journal.pone.0262900.

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Objectives Out-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures. Subject and methods This study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Banglad
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Reid, Eleanor, Arunangshu Ghoshal, Aisha Khalil, et al. "Out-of-pocket costs near end of life in low- and middle-income countries: A systematic review." PLOS Global Public Health 2, no. 1 (2022): e0000005. http://dx.doi.org/10.1371/journal.pgph.0000005.

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Background Globally, there is a rise in chronic disease, including cancer, major organ failure and dementias. Patients and their families in low- and middle-income countries (LMICs) pay a high proportion of medical costs out of pocket (OOP), and a diagnosis of serious illness often has catastrophic financial consequences. We therefore conducted a review of the literature to establish what is known about OOP costs near end of life in LMICs. Aims To identify, organise and report the evidence on out-of-pocket costs in adult end-of-life populations in LMIC. Methods A systematic search of 8 databas
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Alkhodary, Ahmed Abdelmajed, Syed Mohamed Aljunid, Aniza Ismail, Amrizal Muhammad Nur, and Suzana Shahar. "Health Care Utilization and Out-of-Pocket Payments among Elderly with Cognitive Frailty in Malaysia." International Journal of Environmental Research and Public Health 19, no. 6 (2022): 3361. http://dx.doi.org/10.3390/ijerph19063361.

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Background: Cognitive frailty (CF) as a potential risk factor for dementia, functional disability, poor quality of life, and mortality. The aim of this study was to explore the health care-related utilization and out-of-pocket (OOP) expenditures, sociodemographic characteristics, and comorbidities among elderly Malaysians with CF. Methods: A cross-sectional study targeting elderly Malaysian aged ≥65 years was conducted. The study included all participants of the fourth phase of the Malaysian representative Long-Term-Research-Grant-Scheme Towards-Useful-Aging (LRGS-TUA) community-based study. A
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Loganathan, Karthiyayini, Pradeep R. Deshmukh, and Abhishek V. Raut. "Socio-demographic determinants of out-of-pocket health expenditure in a rural area of Wardha district of Maharashtra, India." Indian Journal of Medical Research 146, no. 5 (2017): 654–61. https://doi.org/10.4103/ijmr.ijmr_256_15.

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Background & objectives: In India, health expenditure accounts for less than 5 per cent of the Gross Domestic Product and the level of out-of-pocket (OOP) spending is 69.5 per cent of total health expenditures. OOP expenditure exacerbates poverty and has a negative impact on equity and can increase the risk of vulnerable groups slipping into poverty. This study was conducted to estimate the OOP expenditure on health and catastrophic health expenditure and their socio-demographic determinants in a rural area of Maharashtra, India. Methods: This was a prospective observational study involvin
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Chamwali, Lihoya. "Shielding the Vulnerable: Exploring Health Insurance as Financial Safeguard for Slum Dwellers in Dar es Salaam, Tanzania." NG Journal of Social Development 13, no. 1 (2024): 249–63. http://dx.doi.org/10.4314/ngjsd.v13i1.19.

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This study explores the interplay between health insurance and out-of-pocket (OOP) expenditures among slum dwellers in Dar es Salaam, where financial barriers significantly impact access to healthcare. Given the economic vulnerabilities of these populations, understanding this relationship is crucial for designing effective health policy interventions. Therefore, the purpose of the research is to estimate the effects of health insurance on OOP expenditures among this demographic. Employing a cross-sectional research design, the study collected data from a sample of 400 households using questio
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ÖZER, Mustafa. "Türkiye'de Cepten Yapılan Sağlık Harcamalarının Sosyoekonomik Belirleyicileri." Fiscaoeconomia 7, no. 2 (2023): 1196–211. http://dx.doi.org/10.25295/fsecon.1239845.

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This paper explores socioeconomic determinants of out-of-pocket health care spending in Turkey. I use a nationally representative Turkey sample of the Life in Transition Survey. This paper extends the previous literature by using a new nationally representative survey of Turkey to investigate the factors contributing to out-of-pocket healthcare expenditures. Also, thanks to the data set used, this paper can control maternal education, health status, and perceived relative income variables which cannot be controlled in the previous studies. Overall, I find that growth in income increases out-of
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Portnoy, Allison, Steven Sweet, Dawit Desalegn, Solomon Tessema Memirie, Jane J. Kim, and Stéphane Verguet. "Health gains and financial protection from human papillomavirus vaccination in Ethiopia: findings from a modelling study." Health Policy and Planning 36, no. 6 (2021): 891–99. http://dx.doi.org/10.1093/heapol/czab052.

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Abstract High out-of-pocket (OOP) medical expenses for cervical cancer (CC) can lead to catastrophic health expenditures (CHEs) and medical impoverishment in many low-resource settings. There are 32 million women at risk for CC in Ethiopia, where CC screening is extremely limited. An evaluation of the population health and financial risk protection benefits, and their distributional consequences across socioeconomic groups, from human papillomavirus (HPV) vaccination will be critical to support CC prevention efforts in this setting. We used a static cohort model that captures the main features
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Adeniji, Folashayo Ikenna Peter, Akanni Olayinka Lawanson, and Kayode Omoniyi Osungbade. "The microeconomic impact of out-of-pocket medical expenditure on the households of cardiovascular disease patients in general and specialized heart hospitals in Ibadan, Nigeria." PLOS ONE 17, no. 7 (2022): e0271568. http://dx.doi.org/10.1371/journal.pone.0271568.

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Background Cardiovascular diseases (CVDs) present a huge threat to population health and in addition impose severe economic burden on individuals and their households. Despite this, there is no research evidence on the microeconomic impact of CVDs in Nigeria. Therefore, this study estimated the incidence and intensity of catastrophic health expenditures (CHE), poverty headcount due to out-of-pocket (OOP) medical spending and the associated factors among the households of a cohort of CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan, Nigeria. Met
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Asmat, Ullah, Shaukat Saba, and Tariq Bilal. "Household Socio-Demographic Characteristics and Out of Pocket Educational Expenditure in Pakistan." December 1, 2022. https://doi.org/10.5281/zenodo.7380440.

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The present study conducted to empirically investigate the role of household’s socio-demographic factors in household’s head decision making in case of OOP (Out of Pocket) educational expenditures in Pakistan. The unit record data from Pakistan Social and Living Standard Measurement Survey 2007-08, ROUND-IV was used for this purpose. Descriptive as well as multiple regression model was used to analyze the data. The results of the descriptive statistic revealed that the overall mean OOP educational in Punjab province was three time higher than the Baluchistan province. In case of OO
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"Status Sosial Ekonomi dan Pengeluaran OOP Kesehatan Penyandang Disabilitas." Jurnal Ekonomi Kesehatan Indonesia 10, no. 1 (2025). https://doi.org/10.7454/eki.v10i1.1148.

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In 2020, the number of persons with disabilities in Indonesia reached 22.97 million. One of the main challenges this population faces is the high burden of health expenditures, particularly those that are urgent and unpredictable. This study aims to analyze the influence of socioeconomic status on out-of-pocket (OOP) health expenditures among households with persons with disabilities in Indonesia. A quantitative approach was employed using secondary data from the 2022 National Socioeconomic Survey (Susenas), utilizing the core module (KOR) and the household expenditure module (KP). Data were a
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Ammar, Adam, Andre E. Boyke, Anchelo Vital, et al. "Out-of-pocket Cost of Essential Neurosurgical Procedures: A Systematic Review." HPHR Journal, no. 32 (2021). http://dx.doi.org/10.54111/0001/ff3.

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Introduction 33 million people worldwide face catastrophic health expenditures each year from surgery and anesthesia. This study aims to collate the current literature on out-of-pocket (OOP) costs of Bellwether neurosurgical procedures in low- and middle-income countries (LMICs) to provide a basis for calculations of financial burdens, determine deficits in the literature, and guide further research efforts. Method MEDLINE/PubMed, Embase, Cochrane Library, Google Scholar and Relief Web were searched for articles containing data on OOP costs for neurosurgical Bellwether procedures in LMICs. Of
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Ammar, Adam, Andre E. Boykeb, Anchelo Vital, et al. "Out-of-pocket Cost of Neurosurgical Bellwether Procedures: A Systematic Review." HPHR Journal, no. 32 (2021). http://dx.doi.org/10.54111/0001/ff12.

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Introduction 33 million people worldwide face catastrophic health expenditures each year from surgery and anesthesia. This study aims to collate the current literature on out-of-pocket (OOP) costs of Bellwether neurosurgical procedures in low- and middle-income countries (LMICs) to provide a basis for calculations of financial burdens, determine deficits in the literature, and guide further research efforts. Methods MEDLINE/PubMed, Embase, Cochrane Library, Google Scholar and Relief Web were searched for articles containing data on OOP costs for neurosurgical Bellwether procedures in LMICs. Of
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Farhadi, Shaghayegh, Ali Akbar Fazaeli, and Younes Mohammadi. "The Effect of Health Transformation Plan on Out-of-Pocket Payments of the Hospitalized Patients in Hamedan, Iran." Evidence Based Health Policy, Management and Economics, December 28, 2021. http://dx.doi.org/10.18502/jebhpme.v5i4.8160.

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Background: Out-of-Pocket (OOP) payment is categorized among the critical indicators of health system financing. Given the high hospitalization costs of the hospitals, the ministry of health has attempted to implement Health Transformation Plan (HTP) in Iran to reduce OOP. The purpose of this paper is to show the effects of HTP on OOP payments of the hospitalized patients in Hamedan, Iran.
 Methods: This descriptive-analytical study was carried out on 587 patients in the educational hospitals of Hamedan. The data obtained before and after implementing the HTP was from 2013 to 2015. Data a
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Buunaaim, Alexis D. B., Michel Adurayi Amenah, Dominic Konadu-Yeboah, et al. "Evaluating catastrophic health expenditures among patients with long bone fractures in Ghana's major teaching hospitals: a hospital-based analysis." BMC Health Services Research 25, no. 1 (2025). https://doi.org/10.1186/s12913-025-12250-6.

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Abstract Background In low and middle-income countries like Ghana, out-of-pocket (OOP) payments remain a significant barrier to healthcare access, often leading to catastrophic health expenditures (CHE). This study evaluates the incidence of CHE among patients treated for long bone fractures at Ghana’s major teaching hospitals, providing insight into the economic burdens faced by these patients. Methods This cross-sectional study analyzed data from 2,980 patients with long bone fractures treated at four major teaching hospitals in Ghana from July 2017 to July 2020. We collected demographic, cl
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Rezapour, Aziz, Soraya Norayi Motlagh, Banafsheh Darvishi Teli, Negar Yousefzadeh, and Payam Haghighatfard. "Understanding Household Catastrophic Health Expenditures and Fairness of Financing for Cancer Treatment: A Cross-Sectional Case Study in West of Iran." Health Scope 11, no. 2 (2022). http://dx.doi.org/10.5812/jhealthscope-119827.

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Background: Direct out-of-pocket (OOP) and indirect healthcare payments can limit the household budget and cause several financial problems for the household. Objectives: This study aimed to measure the financial protection and determinants of catastrophic health expenditures (CHEs) for cancer treatment in Shahid Rahimi Hospital, Khorramabad, located in western Iran. Methods: This study was conducted on 220 households of cancer patients in Lorestan Province, Iran. The framework of data collection was based on the World Health Organization (WHO) Global Health Survey. Interviews were conducted w
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Raats, J. H., Y. Chang, D. T. Brameier, N. Ponds, and M. J. Weaver. "Health-Care Costs for Patients with a Lower-Extremity Fracture Have Increased Disproportionately Over the Past 10 Years." Journal of Bone and Joint Surgery, February 19, 2025. https://doi.org/10.2106/jbjs.24.00544.

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Background: Increasing U.S. health-care costs raise concerns regarding the sustainability of the U.S. health-care system, with the potential for negative effects on the mental and physical health of patients. Orthopaedic injuries often impose considerable financial burdens on patients and hospitals, but the trends in, and drivers of, costs remain unclear. This study evaluated the total expenditure and out-of-pocket (OOP) costs of patients with a lower-extremity (LE) fracture in the non-institutionalized U.S. population from 2010 to 2021. Methods: A total of 3,016 participants with an LE fractu
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Mwale, Martin Limbikani, Martina Mchenga, and Gowokani Chijere Chirwa. "A spatial analysis of out-of-pocket payments for healthcare in Malawi." Health Policy and Planning, August 3, 2021. http://dx.doi.org/10.1093/heapol/czab090.

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Abstract Out-of-pocket (OOP) expenditures on health remain high in many low- and middle-income countries despite policy efforts aiming to reduce these health costs by targeting their hotspots. Hotspot targeting remains inadequate, particularly where the OOP expenditures are related across geographic regions due to unequal demand, supply and prices of healthcare services. In this paper, we investigate the existence of geographical correlations in OOP health expenditures by employing a spatial Durbin model on data from 778 clusters obtained from the 2016 Malawi’s Integrated Household Survey. Res
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Batbold, Ochirbat, Tuvshin Banzragch, Davaatseren Davaajargal, and Christy Pu. "Crowding-Out Effect of Out-of-Pocket Health Expenditures on Consumption Among Households in Mongolia." International Journal of Health Policy and Management, August 25, 2021. http://dx.doi.org/10.34172/ijhpm.2021.91.

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Background: High out-of-pocket (OOP) health expenditures are a common problem in developing countries. Studies rarely investigate the crowding-out effect of OOP health expenditures on other areas of household consumption. OOP health costs are a colossal burden on families and can lead to adjustments in other areas of consumption to cope with these costs. Methods: This cross-sectional study used self-reported household consumption data from the nationally representative Household Socioeconomic Survey (HSES), collected in 2018 by the National Statistical Office of Mongolia. We estimated a quadra
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Pu, Christy. "A Clear Breakdown of Out-of-Pocket Spending: Implications for Public Health Policy." Journal of Public Health Issues and Practices 8, no. 2 (2024). https://doi.org/10.33790/jphip1100231.

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Out-of-pocket (OOP) health expenditures play a critical role in shaping global health policies due to their direct impact on financial risk protection, health equity, and access to healthcare services. For policymakers to utilize OOP expenditure data effectively, a nuanced and detailed breakdown is essential. Excessive OOP spending often forces individuals into financial hardship, even in nations with robust health insurance systems [1, 2] making it crucial to comprehend the determinants and nature of these expenses. Misattributing the causes of OOP expenditures can lead to ineffective policy
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Hernández-Vásquez, Akram, Carlos Rojas-Roque, Antonio Barrenechea-Pulache, and Guido Bendezu-Quispe. "Measuring the Protective Effect of Health Insurance Coverage on Out-of-Pocket Expenditures During the COVID-19 Pandemic in the Peruvian Population." International Journal of Health Policy and Management, November 7, 2021. http://dx.doi.org/10.34172/ijhpm.2021.154.

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Background: Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the coronavirus disease 2019 (COVID-19) pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post-mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status. Methods: This study utilized repeated cross-secti
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