Determining Factors Influencing Out-of-Pocket Health Care Expenditures in Low- and Middle-Income Countries: A Systematic Review

Purpose: This study determines the factors influencing the increase in out-of-pocket medical costs in low- and middle-income countries from the reviewed literature. As there is little relevant information available on health expenditure, the findings will help identify research gaps and provide the basis for future studies on rising healthcare costs in developing countries. Failure to address this situation may threaten sustainable development goals. Methodology: A systematic literature search was used to identify relevant studies on out-of-pocket medical expenditure papers published from 2000 to 2022 were included. Of the 3,933 papers on out-of-pocket medical costs in developing countries found from the University of Gothenburg Library through popular databases such as CINAHL, and GUPEA, JUNO, Mediearkivet, NE.se, PubMed, and Scopus, only 14 papers meeting the criteria were included in this study. Relevant literature has been searched by using the following keywords: out-of-pocket, and medical expenses. In research, Boolean terms are used to separate keywords (AND; OR). In our search for eligible studies, health expenditure has been used, PubMed was selected as the one containing the papers under study, and Rayyan software was used as tool for inclusion and exclusion of the selected papers. Findings: Several factors have been identified as having an impact on the rise in out-of-pocket medical costs. However, vulnerable groups who do not understand insurance systems, occupational status, supplemental health insurance, rural residents, people with disabilities, people with chronic illnesses, and families with elderly people, and female-headed households, distance to health facilities, transportation are all factors that contributed to the increase of direct payment of medical expenditure. Research Limitations: The classification of countries is evolving, and the World Bank index is continuously updated. A country that was categorized as low- and middle-income in 2000, for instance, was categorized as a high-income country in 2022. This restriction makes it crucial to continually look at these nations whose economic classifications have changed. Practical Implications: The results will inform both governments and health policymakers to fight against the factors that are pushing the increase of healthcare spending worldwide, especially in developing countries and put in place the strategies of removing those factors in order to achieve the universal health coverage as recommended by world health organization. Originality/Value: Little research has been conducted to date on the factors that influence the direct payment of health care services for in the developing countries. The findings of this research will contribute to the understanding of the features influencing rising healthcare costs in developing countries.