Healthcare Expenditures Across Household Headship and Expenditure Quintiles: Insights From a Household Survey

Using the nationwide cross-sectional 2016 Household Income and Expenditure Survey data compiled by the Department of Census and Statistics of Sri Lanka, this study examines the impact of the heterogeneity induced by gender-based differences in household headship on healthcare consumption expenditure. We separately modeled Out Of Pocket Health expenditures for male and female household head decision-makers across the richest and poorest expenditure quintiles to avoid endogeneity and self-selection bias. Double-hurdle model is used for the study. Estimation results reveal that key determining factors in deciding whether to spend on healthcare and the level of Out Of Pocket Health expenditure varied between male and female-headed households and also across expenditure quintiles. The presence of members with NCD/NCDs or being disabled, household size, age and educational level of the household are significantly influence on participation decision while the living sector, Wealth Index, healthcare seeking behavior and expenditure quintile are significantly influencing on level of spending on healthcare but this effect differs between male vs female headed households in magnitude. The study’s findings highlight the importance of designing separate programs and incentives for males compared with female-headed households in developing countries. This study recommends introducing public health insurance schemes, especially focusing poorest expenditure quintile households and also separate health insurance schemes for female headed households in poorest expenditure quintile.