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Beyond catastrophic payments: modeling household health expenditure shares with endogenous selection

Author

Listed:
  • Antonello Maruotti

    (LUMSA University)

  • Pierfrancesco Alaimo Di Loro

    (LUMSA University)

  • Cathleen Johnson

    (West Virginia University)

Abstract

The primary purpose of this paper is to assess households’ burden due to out-of-pocket healthcare expenditures. These payments are modeled on a representative sample of 25668 Italian households as the fraction of out-of-pocket healthcare expenditures over the households’ capacity to pay. For this purpose, we propose extending the analysis of the so-called catastrophic payments by looking at the entire distribution of this ratio. We introduce a novel finite mixture regression able to capture different levels of heterogeneity in the data. By using such a model specification, the fairness of the Italian National Health Service and its determinants are investigated.

Suggested Citation

  • Antonello Maruotti & Pierfrancesco Alaimo Di Loro & Cathleen Johnson, 2025. "Beyond catastrophic payments: modeling household health expenditure shares with endogenous selection," AStA Advances in Statistical Analysis, Springer;German Statistical Society, vol. 109(2), pages 363-386, June.
    • Handle: RePEc:spr:alstar:v:109:y:2025:i:2:d:10.1007_s10182-024-00519-w
    DOI: 10.1007/s10182-024-00519-w
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    References listed on IDEAS

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    1. Marco Centoni & Vieri Del Panta & Antonello Maruotti & Valentina Raponi, 2019. "Concomitant-Variable Latent-Class Beta Inflated Models to Assess Students’ Performance: An Italian Case Study," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 146(1), pages 7-18, November.
    2. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    3. Frankovic, Ivan & Kuhn, Michael, 2023. "Health insurance, endogenous medical progress, health expenditure growth, and welfare," Journal of Health Economics, Elsevier, vol. 87(C).
    4. Atella, Vincenzo & Deb, Partha & Kopinska, Joanna, 2019. "Heterogeneity in long term health outcomes of migrants within Italy," Journal of Health Economics, Elsevier, vol. 63(C), pages 19-33.
    5. Leila Doshmangir & Edris Hasanpoor & Gerard Joseph Abou Jaoude & Behzad Eshtiagh & Hassan Haghparast-Bidgoli, 2021. "Correction to: Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta‑analysis," Applied Health Economics and Health Policy, Springer, vol. 19(6), pages 953-953, November.
    6. Rainer Winkelmann, 2004. "Health care reform and the number of doctor visits-an econometric analysis," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 19(4), pages 455-472.
    7. William Greene, 2009. "Models for count data with endogenous participation," Empirical Economics, Springer, vol. 36(1), pages 133-173, February.
    8. Flores, Gabriela & O’Donnell, Owen, 2016. "Catastrophic medical expenditure risk," Journal of Health Economics, Elsevier, vol. 46(C), pages 1-15.
    9. Salvatore D. Tomarchio & Antonio Punzo, 2019. "Modelling the loss given default distribution via a family of zero‐and‐one inflated mixture models," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 182(4), pages 1247-1266, October.
    10. Leila Doshmangir & Edris Hasanpoor & Gerard Joseph Abou Jaoude & Behzad Eshtiagh & Hassan Haghparast-Bidgoli, 2021. "Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis," Applied Health Economics and Health Policy, Springer, vol. 19(6), pages 839-855, November.
    11. Jeetendra Yadav & Geetha R. Menon & Denny John, 2021. "Disease-Specific Out-of-Pocket Payments, Catastrophic Health Expenditure and Impoverishment Effects in India: An Analysis of National Health Survey Data," Applied Health Economics and Health Policy, Springer, vol. 19(5), pages 769-782, September.
    12. Deb, Partha & Trivedi, Pravin K., 2002. "The structure of demand for health care: latent class versus two-part models," Journal of Health Economics, Elsevier, vol. 21(4), pages 601-625, July.
    13. Paul Eze & Lucky Osaheni Lawani & Ujunwa Justina Agu & Linda Uzo Amara & Cassandra Anurika Okorie & Yubraj Acharya, 2022. "Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review," PLOS ONE, Public Library of Science, vol. 17(10), pages 1-28, October.
    14. Adam Wagstaff, 2019. "Measuring catastrophic medical expenditures: Reflections on three issues," Health Economics, John Wiley & Sons, Ltd., vol. 28(6), pages 765-781, June.
    15. Frondel, Manuel & Vance, Colin, 2013. "On Interaction Effects: The Case of Heckit and Two-part Models," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 233(1), pages 22-38.
    16. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    17. Panagiota Filippou & Giampiero Marra & Rosalba Radice & David Zimmer, 2023. "Estimating the Impact of Medical Care Usage on Work Absenteeism by a Trivariate Probit Model with Two Binary Endogenous Explanatory Variables," AStA Advances in Statistical Analysis, Springer;German Statistical Society, vol. 107(4), pages 713-731, December.
    18. Pu Liao & Xun Zhang & Wanlu Zhang, 2022. "Endogenous health risks, poverty traps, and the roles of health insurance in poverty alleviation," Health Economics Review, Springer, vol. 12(1), pages 1-15, December.
    19. Antonello Maruotti, 2009. "Fairness of the national health service in Italy: a bivariate correlated random effects model," Journal of Applied Statistics, Taylor & Francis Journals, vol. 36(7), pages 709-722.
    20. HyunWoo Jung & Kwang-Soo Lee, 2022. "What Policy Approaches Were Effective in Reducing Catastrophic Health Expenditure? A Systematic Review of Studies from Multiple Countries," Applied Health Economics and Health Policy, Springer, vol. 20(4), pages 525-541, July.
    21. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
    22. Wouterse, Bram & Huisman, Martijn & Meijboom, Bert R. & Deeg, Dorly J.H. & Polder, Johan J., 2013. "Modeling the relationship between health and health care expenditures using a latent Markov model," Journal of Health Economics, Elsevier, vol. 32(2), pages 423-439.
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