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Decomposition of inequalities in out-of-pocket health expenditure burden in Saudi Arabia

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  • Al-Hanawi, Mohammed Khaled

Abstract

Out-of-pocket (OOP) health expenditure remains a serious welfare problem worldwide. The aim of this study was to investigate and decompose factors that are associated with inequalities in relative OOP health expenditure, estimated as the percentage of income spent on healthcare, in Saudi Arabia. Data from 10,785 respondents were obtained from a national cross-sectional survey conducted in Saudi Arabia as a part of the 2018 Family Health Survey. Inequalities in relative OOP health expenditure were measured using concentration indices and concentration curves. Moreover, the Wagstaff approach was used to decompose the concentration index of relative OOP health expenditure to assess the contribution of each of its determinants. The results revealed that relative OOP health expenditure in Saudi Arabia are concentrated among the poor (concentration index = −0.151, p < 0.01), resulting in a greater burden for the poor. Decomposition of the factors that contribute to this inequality revealed heterogeneity. Specifically, factors that increase the burden amongst the poor included aged above 60 years, and low levels of education, whereas factors that increase the burden amongst the rich included male gender, below the age of 60 years, secondary and higher education, having health insurance coverage, and suffering from chronic illnesses. Importantly, these results demonstrate that poor people might be exposed to hazardous health spending. Therefore, efforts to curbing OOP health expenditure should be framed by taking into account the specific factors that drive the burden towards the poor, such as older age and lack of education, so as to safeguard the overall welfare of the poor.

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  • Al-Hanawi, Mohammed Khaled, 2021. "Decomposition of inequalities in out-of-pocket health expenditure burden in Saudi Arabia," Social Science & Medicine, Elsevier, vol. 286(C).
    • Handle: RePEc:eee:socmed:v:286:y:2021:i:c:s0277953621006547
    DOI: 10.1016/j.socscimed.2021.114322
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    1. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, vol. 154(C), pages 122-136.
    2. Emily J. Callander & Haylee Fox & Daniel Lindsay, 2019. "Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system," Health Economics Review, Springer, vol. 9(1), pages 1-8, December.
    3. Zhang, Anwen & Nikoloski, Zlatko & Mossialos, Elias, 2017. "Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly," Social Science & Medicine, Elsevier, vol. 190(C), pages 11-19.
    4. Heckley, Gawain & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2016. "A general method for decomposing the causes of socioeconomic inequality in health," Journal of Health Economics, Elsevier, vol. 48(C), pages 89-106.
    5. Al-Hanawi, Mohammed K. & Alsharqi, Omar & Vaidya, Kirit, 2020. "Willingness to pay for improved public health care services in Saudi Arabia: a contingent valuation study among heads of Saudi households," Health Economics, Policy and Law, Cambridge University Press, vol. 15(1), pages 72-93, January.
    6. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    7. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
    8. Mohammed Khaled Al-Hanawi & Omar Alsharqi & Saja Almazrou & Kirit Vaidya, 2018. "Healthcare Finance in the Kingdom of Saudi Arabia: A Qualitative Study of Householders’ Attitudes," Applied Health Economics and Health Policy, Springer, vol. 16(1), pages 55-64, February.
    9. Ebaidalla M. Ebaidalla & Mohammed Ehaj Mustafa Ali, 2019. "Determinants and impact of household's out-of-pocket healthcare expenditure in Sudan: evidence from urban and rural population," Middle East Development Journal, Taylor & Francis Journals, vol. 11(2), pages 181-198, July.
    10. Richard Mussa, 2016. "Exit from catastrophic health payments: a method and an application to Malawi," International Journal of Health Economics and Management, Springer, vol. 16(2), pages 163-174, June.
    11. Purity Njagi & Jelena Arsenijevic & Wim Groot, 2020. "Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-17, December.
    12. Mohammad Imdadul Haque & Md Riyazuddin Khan, 2019. "Role of Oil Production and Government Expenditure in Improving Human Development Index: Evidence from Saudi Arabia," International Journal of Energy Economics and Policy, Econjournals, vol. 9(2), pages 251-256.
    13. Ebaidalla M. Ebaidalla & Mohammed Ehaj Mustafa Ali, 2019. "Determinants and impact of household's out-of-pocket healthcare expenditure in Sudan: evidence from urban and rural population," Middle East Development Journal, Taylor & Francis Journals, vol. 11(2), pages 184-204, July.
    14. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
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    2. Pu, Christy & Lee, Miaw-Chwen & Hsieh, Tsung-Che, 2023. "Income-related inequality in out-of-pocket health-care expenditures under Taiwan's national health insurance system: An international comparable estimation based on A System of Health Accounts," Social Science & Medicine, Elsevier, vol. 326(C).

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