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Article
Publication date: 18 February 2021

Yong Kang Cheah, Kim-Leng Goh and Azira Abdul Adzis

The objective of this study is to examine the sociodemographic factors that are associated with health care expenditure among households in Malaysia.

Abstract

Purpose

The objective of this study is to examine the sociodemographic factors that are associated with health care expenditure among households in Malaysia.

Design/methodology/approach

This study examines health care participation decision and amount of expenditure using the exponential Type 2 Tobit model. A dataset of a large sample (n = 14,838) that is nationally representative is used.

Findings

The results suggest that household size, location of residence as well as age, education and marital status of the household heads are significantly associated with household expenditure on health care. Health care expenditure increases with the age and educational attainment of household heads, whereas those who are being employed and residing in rural areas have lower health care expenditure. Although larger households are more likely to consume health care than smaller households, they spend less on health care. Furthermore, marital status does not affect the participation decision of health care expenditure, but the variable is associated with the decision on the amount of the expenditure.

Practical implications

The results provide insights into groups of population that can be targeted for healthcare intervention programmes and policy design.

Originality/value

This study is the first to our knowledge to use a microeconometric approach to analyse the health care participation as well as its level of expenditure among households in Malaysia.

Details

International Journal of Social Economics, vol. 48 no. 4
Type: Research Article
ISSN: 0306-8293

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Article
Publication date: 4 December 2017

Noah Olasehinde and Olanrewaju Olaniyan

The purpose of this paper is to examine the determinants of health expenditure at the household level in Nigeria with specific focus on the household and individual unique…

Abstract

Purpose

The purpose of this paper is to examine the determinants of health expenditure at the household level in Nigeria with specific focus on the household and individual unique characteristics. It presents some stylised facts about the Nigerian health system and its financing options. It went further to show that household is the major financial organ of healthcare in Nigeria. The study aims to expand the domain of household health expenditure by analysing at national, urban and rural levels.

Design/methodology/approach

It adopted Engel curve approach, which was estimated using ordinary least squares technique. The model was structured to take care of life-cycle implications by examining effects of age in years and age groups (0-9, 10-19, 20-39, 40-59 and 60+) on healthcare spending. Data were drawn from the 2010 Harmonised Nigeria Living Standards Survey (HNLSS) conducted by the National Bureau of Statistics and analyses were conducted nationally, for urban and rural locations.

Findings

The result shows that individual characteristics like age, religion, education and household characteristics like income, size and headship commonly influence healthcare expenditure in Nigeria significantly. The household-level variables possess stronger significant effects among the rural households while marital status and employment had differential effects in both urban and rural locations. It also confirmed that Nigeria engages in intergenerational transfer of healthcare by the working population to the young and older generations.

Research limitations/implications

HNLSS was only limited to those who were sick or injured in the last two weeks preceding the survey, leaving out those whose sickness preceded the two weeks before the survey. Also, the scope of health expenditure is limited to curative care spending that exclude expenses on preventive care, rehabilitative care as well as other cost-saving services.

Originality/value

This paper fulfils an identified need to examine the determinants of household health expenditure at the national, urban and rural locations.

Details

International Journal of Social Economics, vol. 44 no. 12
Type: Research Article
ISSN: 0306-8293

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Article
Publication date: 10 December 2020

Milan Das, Kaushalendra Kumar and Junaid Khan

The purpose of this paper is to examine the dynamic nature of the catastrophic health expenditure (CHE) on remittances receiving households between 2005 and 2012 in India.

Abstract

Purpose

The purpose of this paper is to examine the dynamic nature of the catastrophic health expenditure (CHE) on remittances receiving households between 2005 and 2012 in India.

Design/methodology/approach

The study adopted Xu’s (2005) definition of catastrophic health-care expenditure. And also used binary logistic regression to examine the effects of remittances being received on CHE in households across India. The data were drawn from the two rounds of the India Human Development Survey conducted by the University of Maryland, the USA, and the National Council of Applied Economic Research, New Delhi, India.

Findings

The results show that the percentage of households received remittances, and that the amount of remittances received has substantially increased during 2005 and 2012, though variation is evident by socioeconomic and demographic characteristics of the household. Apparently, the variation (percentage of households received remittances) is more pronounced for factors such as household size, number of 60+ elderly, sectors and by regions. Household’s catastrophic health spending and remittances being received show a statistically significant association. Households which received remittances during both the time showed the lowest likelihood (AOR:0.82; p-value < 0.10; 95% CI:0.64–1.03) to experience catastrophic health spending.

Originality/value

The paper identified the research gap to examine the occurrence of catastrophic health spending by remittances receiving status of the household using a novel panel data set.

Details

International Journal of Migration, Health and Social Care, vol. 16 no. 4
Type: Research Article
ISSN: 1747-9894

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Article
Publication date: 17 June 2020

Samuel Ampaw, Edward Nketiah-Amponsah, Frank Agyire-Tettey and Bernardin Senadza

Equity in access to and use of healthcare resources is a global development agenda. Policymakers’ knowledge of the sources of differences in household healthcare spending…

Abstract

Purpose

Equity in access to and use of healthcare resources is a global development agenda. Policymakers’ knowledge of the sources of differences in household healthcare spending is crucial for effective policy. This paper aims to investigate the differences in the determinants of household healthcare expenditure across space and along selected quantiles of healthcare expenditure in Ghana. The determinants of rural-urban healthcare expenditure gap are also explored.

Design/methodology/approach

Data was obtained from the sixth round of the Ghana Living Standards Survey (GLSS 6) conducted in 2013. An unconditional quantile regression (UQR) and a decomposition technique based on UQR, adjusted for sample selection bias, were applied.

Findings

The results indicate that differences in the determinants of household healthcare expenditure across space and along quantiles are driven by individual-level variables. Besides, the rural-urban health expenditure gap is greatest among households in the lower quantiles and this gap is largely driven by differences in household income per capita and percentage of household members enrolled on health insurance policies.

Originality/value

The findings show that there are differences in the determinants of household health expenditure along with the income distribution, as well as between rural and urban localities, which would call for targeted policies to address these inequalities.

Details

International Journal of Development Issues, vol. 19 no. 3
Type: Research Article
ISSN: 1446-8956

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Article
Publication date: 14 August 2018

Samuel Ampaw, Edward Nketiah-Amponsah, Nkechi Srodah Owoo and Bernardin Senadza

Rural poverty remains high in many developing countries, Ghana inclusive. This has implications for healthcare affordability and utilization, and thus the attainment of…

Abstract

Purpose

Rural poverty remains high in many developing countries, Ghana inclusive. This has implications for healthcare affordability and utilization, and thus the attainment of universal health coverage. Nonfarm diversification is seen as a means by which rural farm households can increase incomes and smooth consumption including healthcare. The purpose of this paper is to investigate the impact of nonfarm enterprise participation on healthcare expenditure among farm households in rural Ghana.

Design/methodology/approach

Using nationally representative household data from the sixth round of the Ghana Living Standards Survey (GLSS 6), the paper employs endogenous switching regression and propensity score matching techniques to account for potential selectivity bias.

Findings

Results indicate that households that participate in nonfarm enterprises earn higher incomes and expend more on healthcare. Total household income and region of residence are significant determinants of healthcare expenditure among farm households in rural Ghana. In addition, while in nonfarm enterprise nonparticipating households the marital status of the head of household is important, for participating households the head having at least secondary education significantly influences healthcare expenditure.

Practical implications

Promoting nonfarm activities and hence raising the incomes of households in rural areas of Ghana has the potential of increasing health capital through increased investments in health. It will also positively impact access to and utilization of healthcare and ultimately contribute towards increased farm and non-farm productivity.

Originality/value

Previous studies have only examined the determinants of nonfarm enterprise participation or its impact on household welfare, poverty, inequality, food security and agricultural investments. While evidence abounds on the positive impact of rural nonfarm enterprise participation on household income, which in turn has implications for household health expenditure, the potential positive link between rural nonfarm enterprise participation and household healthcare expenditure remains unexamined.

Details

International Journal of Social Economics, vol. 46 no. 1
Type: Research Article
ISSN: 0306-8293

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Article
Publication date: 28 December 2020

Ernesto Aguayo-Téllez, Adelaido García-Andrés and Jose N. Martinez

This paper aims to analyse the differential impact of foreign and domestic remittances on household expenditure shares.

Abstract

Purpose

This paper aims to analyse the differential impact of foreign and domestic remittances on household expenditure shares.

Design/methodology/approach

This study uses micro-data from a very large and detailed income-expenditure survey in Mexico and runs consumption-share Engel equations to estimate income (expenditure) elasticities for different consumption goods groups. Trying to account for the standard problems of endogeneity, this paper considers only nuclear households with migrant fathers and compare households that receive remittances from abroad, from within Mexico and those not receiving remittances.

Findings

This study finds that international remittances have a larger impact on the expenditure shares of women’s clothes, insurances and durable goods, while domestic remittances have a larger impact on the share of income dedicated to food, health and education.

Originality/value

Based on the results, differences in consumption shares between families receiving foreign and domestic remittances might depend not only on the relative size of the income transfer but also on the nature of the transfer and the sender’s capacity to monitor in person the use of those remittances. The results indicate that households that receive remittances from abroad present higher shares of consumption of some goods the literature commonly associates with the mothers’ preferences.

Details

International Journal of Development Issues, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1446-8956

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Article
Publication date: 16 September 2019

Satar Rezaei, Mohammad Hajizadeh, Sina Ahmadi, Sadaf Sedghi, Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad and Enayatollah Homaie Rad

Financial protection of households against catastrophic healthcare expenditure (CHE) is defined as one of the main goals in health systems. The purpose of this paper is to…

Abstract

Purpose

Financial protection of households against catastrophic healthcare expenditure (CHE) is defined as one of the main goals in health systems. The purpose of this paper is to measure and decompose socioeconomic inequality in CHE among households in Kermanshah province, Western of Iran.

Design/methodology/approach

This cross-sectional study was carried out among 1,188 households in 2017. Data were extracted from the Household Income and Expenditure Survey which is conducted by the Statistical Center of Iran. The CHE is defined as household healthcare expenditure greater than or equal to the 40 percent of household’s “capacity to pay.” The concentration curve and the Wagstaff (W) and Erreygers (E) indexes were used to illustrate and measure the extent of socioeconomic inequality in CHE. In addition, the authors decomposed the W and E indexes to identify the main determinants of socioeconomic inequality in CHE.

Findings

The results indicated that the prevalence of CHE among households was 4.12 percent (95% confidence interval (CI): 3.13 to 5.42 percent). The estimated value of the W and E indexes were −0.2849 (95% CI: −0.4493 to −0.1205) and −0.0451 (95% CI: −0.0712 to −0.0190), respectively; suggesting the concentration of CHE prevalence among the poor households. Decomposition analyses indicated socioeconomic status as the most important factor contributing to the concentration of CHE among the poor. In contrast, health insurance coverage was found to increase the concentration of CHE among the rich in Iran.

Originality/value

The current study demonstrated a higher concentration of CHE among the poor households in Kermanshah province. These results call for the government’s efforts to reduce healthcare expenditure among socioeconomically disadvantaged populations. Further studies are required to understand the mechanisms through which health insurance coverage increased the probability of CHE among rich in Kermanshah province.

Details

International Journal of Social Economics, vol. 46 no. 9
Type: Research Article
ISSN: 0306-8293

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Book part
Publication date: 8 December 2007

Kristiano Raccanello, Jayant Anand and Eder Gibran Bielma Dolores

Evidence from developed countries shows debt and bankruptcy to be correlated with medical expenditures. In Mexico, the formal financial sector does not lend for health

Abstract

Evidence from developed countries shows debt and bankruptcy to be correlated with medical expenditures. In Mexico, the formal financial sector does not lend for health needs. So, the solution is often found by borrowing from relatives, friends, and moneylenders, or pawning belongings after using savings, if any. Despite the recent and growing literature on income and health, and health financing, we have not come across a single study analyzing pawning and health. Our study fills this gap using a sample of 400 government owned pawnshop users from Puebla, Mexico. The findings from the study revealed that health expenditures are a significant reason for pawning and having medical insurance does not reduce the probability to pawn. Also, catastrophic health expenditures are correlated with a higher probability of not redeeming the pledge. We found that most pawnshop users have low income and losing a pledge is positively correlated with low or middle income and the number of people in the household.

Details

The Economics of Health and Wellness: Anthropological Perspectives
Type: Book
ISBN: 978-1-84950-490-4

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Article
Publication date: 12 February 2018

Jacob Novignon, Justice Nonvignon and Richard Mussa

Understanding the linkages between poverty and inequality is vital to any sustainable development and poverty reduction strategies. In Ghana, while poverty has reduced…

Abstract

Purpose

Understanding the linkages between poverty and inequality is vital to any sustainable development and poverty reduction strategies. In Ghana, while poverty has reduced significantly over the years, inequality has increased. The purpose of this paper is to examine the linkages between inequality in household expenditure components and overall inequality and poverty in Ghana.

Design/methodology/approach

Using microdata from the sixth round of the Ghana Living Standards Survey (GLSS 6) conducted in 2012/2013, marginal effects and elasticities were computed for both within- and between-component analysis.

Findings

The results suggest that, in general, reducing within-component inequality significantly reduces overall poverty and inequality in Ghana, compared with between-component inequality. Specifically, inequality in education and health expenditure components were the largest contributors to overall poverty and inequality. The findings imply that policies directed toward reducing within-component inequality will be more effective. Specifically, the findings of the study corroborate recent policies on education and health in Ghana aimed at inequality within these components. Sustaining and scaling up these policies will be a step in the right direction.

Originality/value

The study contributes to existing studies in several ways: first, this study becomes the first attempt to examine inequality-poverty nexus using household expenditure components in Ghana. Second, the use of expenditure in place of income is an addition to the literature. Income is usually subject to reporting biases and is minimal in expenditure. Finally, the findings highlight the need for poverty reduction strategies to focus on specific household components including education and health. Blanket interventions may not be effective in reducing inequality and poverty.

Details

International Journal of Social Economics, vol. 45 no. 2
Type: Research Article
ISSN: 0306-8293

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Book part
Publication date: 30 December 2013

Therese Nilsson and Andreas Bergh

There is an on-going debate as to whether health is negatively affected by economic inequality. Still, we have limited knowledge of the mechanisms relating inequality to…

Abstract

There is an on-going debate as to whether health is negatively affected by economic inequality. Still, we have limited knowledge of the mechanisms relating inequality to individual health and very little evidence comes from less-developed economies. We use individual and multi-level data from Zambia on child nutritional health to test three hypotheses consistent with a negative correlation between income inequality and population health: the absolute income hypothesis (AIH), the relative income hypothesis (RIH) and the income inequality hypothesis (IIH). The results confirm that absolute income positively affects health. For the RIH we find sensitivity to the reference group used. Most interestingly, we find higher income inequality to robustly associate with better child health. The same pattern appears in a cross country regression. To explain the conflicting results in the literature we suggest examining potential mediators such as generosity, food sharing, trust and purchasing power.

Details

Health and Inequality
Type: Book
ISBN: 978-1-78190-553-1

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