AUTHOR=Bashir Saima , Kishwar Shabana , Nasir Muhammad , Ali Shehzad 

TITLE=Socioeconomic Inequalities in Out-of-Pocket and Catastrophic Health Expenditures in Pakistan

JOURNAL=International Journal of Public Health

VOLUME=Volume 69 - 2024

YEAR=2024

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2024.1607313

DOI=10.3389/ijph.2024.1607313

ISSN=1661-8564

ABSTRACT=Objectives: In Pakistan, health care utilization is linked to out-of-pocket payments (OOP), impacting household finances inequitably. We investigated socioeconomic inequality in OOP and catastrophic health expenditures (CHEs), and contribution of sociodemographic factors in these inequalities.  Methods: Socioeconomic inequalities were measured using concentration index (CI), the slope (SII) and relative (RII) indices using three rounds of Household Integrated Economic Survey (2007-08, 2011-12, and 2018-19). Decomposition analyses were conducted by following Wagstaff and Erreygers. Results: OOP payments increased from PKR 127 (2007-08) to PKR 250 (2018-19). CHEs in the most deprived quintile (Q1) increased from 8.3% (2007-08) to 13.7% (2018-19), and for least deprived quintile (Q5) from 5.1% (2007-08) to 8.4% (2018-19). OOP CI increased from 0.028 to 0.051, while SII and RII increased from 0.89 to 1.32 and 1.18 to 1.36, respectively. Decomposition analysis showed that household size, composition, employment, and province of residence explained socioeconomic inequality in CHE. Conclusion: Poor households experience high CHE, impacting larger families with children and elderly members. Policymakers should implement targeted financial protection strategies to safeguard vulnerable households from the impoverishing effects of healthcare expenses.