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The purpose of this paper is to decompose the inequities induced by the Nigerian health care financing sources and their effect on the income distribution. Inequities in health care financing sources are of immense policy concern particularly in developing countries such as Nigeria, where high-level income inequality exists, and the cost of medical care is generally financed out-of-pocket (OOP) due to limited access to health insurance.

The Duclos et al. decomposition model provided the theoretical framework for the study. Data were obtained from two waves of the Nigeria General Household Survey (GHS) panel, 2012–13 and 2015–16. The analysis covered 3,999 households in 2012–13 and 4,051 households in 2015–16. Two measures of health care financing: OOP payment and health insurance contribution (HIC) were used. The ability to pay measure was household consumption expenditure.

The major inequity issue induced by the OOP payments was vertical inequity. HICs created the problems of vertical inequity, horizontal inequity and reranking among households. Overall both health care financing options were associated with the worsening of income inequality both at the national and sectorial levels in the country. The operations of the NHIS need to be improved to ensuring improved health care coverage for the poor.

This paper fulfills an identified need to determine the income redistributive effects (REs) of the social health insurance (SHI) contribution at the national, urban and rural locations overtime.

The purpose of this study was to see the impact of increased out-of-pocket expenditure oh health care exerting budget pressure on households, which leads to change in dietary consumption.

It was a hospital-based cross-sectional study comprising 414 patients with a chronic or major illness attending a large tertiary care public hospital at Delhi, India. Each patient represented a household with total number of family members of 2,550 in the study. Questionnaire was used to gather data on factors responsible for changes in consumption of 12 major food items.

Moderate decrease in food consumption of a household after major illness is associated with: rural residence (p < 0.001), decrease in savings (p < 0.001), more number of household items sold (p < 0.001), education of the children affected (p < 0.001), upper socio-economic status (SES) (p < 0.001) and children started working after illness in family (p = 0.043). In addition to decrease in food items, there was also deterioration in quality of food preparation. More than 80% of the families did not change the intake of cereals (rice and wheat), pulses and sugar. Food items that were decreased by most families were fruits, followed by milk and its products, vegetables, meat and egg, oils and ghee.

This study is a subset of other two studies previously published. The authors had not been able to cover this aspect fully in those two studies but understood the importance of impact of expenditure on illness on food consumption. The authors studied change in food consumption pattern (not amount) in subjects after illness. The impact of weather changes in food consumption on the impacted nutritional status of family has not been studied. The authors only collected cross-sectional, observational data and recall bias cannot be completely ruled out and corrected. With such data, only associations could be concluded, not causality. The illness condition of a household was measured by presence of chronic disease and inpatient treatment. Such measures did not take into account the types of illness and number of episodes. Data of this study cannot capture whether food intake of family prior to illness was sufficient/in excess/deficient. The Kuppuswamy scale, mostly used in urban and peri-urban settings, was also used for rural subjects in the study, which might have resulted in impaired capture of rural SES. The authors did not assess whether families were allocated food grains by schemes like public distribution system, which might have resulted in biased decrease in food consumption. Questionnaire used was not validated.

This study demonstrates the various factors that act as barriers to proper food consumption, including non-financial factors. The policy of user fee in government is hitting poorer section, and equity and access to health are compromised. Health expenditure should be increased by public sector policies to implement uniform healthcare. There is need for more studies to identify measures that could be put in place when designing policies and interventions for the uniform distribution of benefits.

The policy of user fee in government is hitting poorer section, and equity and access to health are compromised. Health expenditure should be increased by public-sector policies to implement uniform healthcare.

Major or chronic illness affects money acquisition and priorities of expenditure, resulting in deterioration in quality of food consumption and by a household.

The purpose of this paper is to explore the determinants of health insurance ownership of individuals in the Sri Lankan labor force and to examine how insurance ownership impacts healthcare utilization.

The authors first used logit model to explore determinants of health insurance ownership. The authors then employed propensity score matching method to estimate impact of insurance ownership on healthcare utilization. Data were obtained from national survey of self-reported health in Sri Lanka – 2014 (n=59,276). National survey of self-reported health in Sri Lanka – 2014 was conducted by the Department of Census and Statistics from January to December 2014.

Results showed that individuals with higher educational attainments, headed by literate-heads, based in urban sector, employed in formal sector, and with health adversities and higher degree of risk propensity are more inclined to have a health cover. Health insurance ownership reduces the likelihood of utilizing public facilities while increasing the likelihood of utilizing private facilities for non-communicable diseases (NCDs) and acute illnesses. Welfare consequences of expanding insurance ownership are doubtful due to oligopolistic private healthcare market and adverse selection issue faced by insurers in Sri Lanka.

This is the first study examining health insurance–healthcare utilization nexus based on Sri Lanka-wide microdata. Also, the study applies bias-corrected matching methods to establish causal links between two constructs. Without being so generalized, healthcare utilization is examined in terms of NCD care and Acute illnesses care, which improves robustness of results and leads to evidence-based healthcare policies.

The peer review history for this paper is available at: https//publons.com/publon/10.1108/IJSE-05-2019-0333.

This study aims to calculate the inequity in out of pocket expenditures and utilization of laboratory tests in Iran. Equal access to health services is an important part of human rights in health care. Out-of-pocket payment is a part of financial access to health care. In this study, the authors tried to find inequity in out-of-pocket payments and utilization of medical laboratory tests (MLTs) as a part of human rights in Iran in 2016.

Gini and concentration indices were calculated for this purpose, and regression models were estimated to show the relationship between different factors and utilization and out-of-pocket.

The average out-of-pocket payment for all of the households was US$1.56 (urban areas: 1.97 and rural areas: 1.31). Moreover, the average utilization of MLTs was 0.079 (urban areas: 0.0908 and rural areas: 0.0753). Gini and concentration indices for out-of-pocket payments were 0.522 and 0.0701, respectively.

Out-of-pocket and utilization were low in lower in less developed regions of ease and southeast regions of the country and were related to access to health insurance, income and wealth deciles.

There is limited evidence on the determinants of hospitalisation and its causes in India. This study aims to examine the differential in the hospitalisation rates and its socioeconomic determinants. This study also examines the causes of diseases in hospitalisation among the elderly (≥60 years) in India.

This study used data from the 75th round of the National Sample Survey Organizations, collected from July 2017 to June 2018. The elderly samples in this survey are 42,759, where 11,070 were hospitalised, and 31,689 were not hospitalised in the past year or 365 days. This study estimated hospitalisation rates and carried out binary logistic regression analysis to examine the associations of hospitalisation with the background variables. The cause of diseases in hospitalisations was also calculated.

The hospitalisation rate was lower among elderly female compared to elderly male. Elderly who belongs to middle-old aged groups, non-married, North-Eastern region, Southern region, general caste, health insurance, partially and fully economically dependent have a higher chance of being hospitalised. About 38% elderly were hospitalised due to communicable diseases (CDs), 52% due to non-communicable diseases (NCDs) and 10% due to injuries and others (IO). Nearly 40% elderly were hospitalised in public hospitals due to CDs, whereas 52% were hospitalised in private hospitals due to NCDs and 11% due to IO.

Firstly, this study is based on cross-sectional survey due to which temporal ambiguity averted to draw causal inferences. Secondly, other significant factors can also predict hospitalisations and provide insightful results, such as lifestyle factors, behavioral factors, obesity, mental state and several personal habits such as smoking cigarettes, drinking alcohol, consuming tobacco or other harmful substances. But this information was not available in this study. Even with these limitations, the hospitalisation issues among the elderly are beneficial to understand the current circumstances of CDs, NCDs and injury and other diseases for India and its states to formulate health policy.

Early screening and early treatment for NCDs are needed, which are non-existent in almost all parts of India. It is essential to necessitate and identify the important factors that best predict hospitalisation or re-visit of hospital admission. Although, the medical advances in India have made rapid strides in the past few decades, it is burdened none the less, as the doctor–patient ratio is very low. It is important to develop preventive measures to minimize the accidents and causalities to avoid substantial cost associated with elderly health care.

Raising awareness, promotion of healthy life style and improving the quality of good health-care provisions at primary level is a necessity.

The findings, practical and social implications provide a way forward for the health policymakers to potentially alter the future research to reduce associated comorbidities, unnecessary hospitalisations and other medical complications.

In May 2014, a new reform in the health sector of Iran was implemented called “health evolution plan.” In the first phase of this reform, the government reduced out-of-pocket payments for service delivery by paying subsidies to the services and after that a revision was done to the medical services values book to improve equity and increase motivation of health professions. One of the affected services in this reform was coronary artery bypass surgery. The purpose of this paper is to show the effects of HEP on costs of coronary artery bypass surgery.

A before-after study was done for this purpose and 167 patients’ total costs and out-of-pocket payments were calculated for the years 2013 (before) and 2014 (after) the reform in three private hospitals of Rasht city, Iran. Econometrics models were estimated after adjustment of confounding variables.

The results of this study showed that surgery costs increased significantly from $1,643.3 to 2,119.5. Nursing and other costs increased significantly from $290.3 to 414.2 and anesthetize costs increased from $619.2 to 947.01. The results of regression model showed that total costs increased $3,008.6 after adjustment of confounders (p-value=0.037). However, no significant changes were found for out-of-pocket payments and out-of-pocket percentage.

The study findings revealed that HTP was not successful enough in financial protection in the private sector.

The study aims to address a critical gap in existing healthcare payment schemes and care service pricing by recognizing the influential role of patients' decisions on self-management efforts. These decisions not only impact health outcomes but also shape the demand for care, subsequently influencing care costs. Despite the significance of this interplay, current payment schemes often overlook these dynamics. The research focuses on investigating the implications of a novel behavior-based payment scheme, designed to align incentives and establish a direct connection between patients' decisions and care costs. The primary objective is to comprehensively understand whether and how this innovative payment scheme structure influences key stakeholders, including patients, care providers, insurers and overall social welfare.

In this paper, we propose a game-theoretical model to incorporate the performance of self-management with the demand for healthcare service, compare the patient's effort decision for self-management and provider's price decision for healthcare service under a behavior-based scheme with that under two implemented widely payment schemes, that is, co-payment scheme and co-insurance scheme.

Our findings confirm that the behavior-based scheme incentives patient self-management more than current schemes while reducing their possibility of seeking healthcare service, which indirectly induces the provider to lower the price of the service. The stakeholders' utility under various payment schemes is sensitive to the cost of treatment and the perceived health utility of patients. Especially, patient health awareness is not always benefited provider profit, as it motivates patient self-management while diminishing the demand for care.

We provide a novel framework for characterizing behavior-based payment schemes. Our results confirm the need for modification of the current payment scheme to incentivize patient self-management.

This paper offers a conceptualization of two dimensions of health care markets in the US, their interaction, and implications of that interaction. The combination of the amount of consumer out-of-pocket financial responsibility and the level of information available to consumers about services and pricing (along with accompanying potential decision-making empowerment) may well determine the way in which health care consumers will interact with health insurers and providers for many years to come. This paper presents a way to model the interaction of these dimensions. The interaction yields four possible future scenarios for health care in the US. These scenarios, in turn, can assist the major stakeholders in the health care system in what may well prove to be fate-making decisions. Finally, different scenarios suggest different entrepreneurial activity.

This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.

The authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.

Findings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.

Publicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.

This paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.

Informal payments in health care exist in many countries around the world. However, the prevalence of informal payments varies between countries. A distinction between illegal or unethical informal payments like bribes and corruption, and legal and ethical forms of informal payment like giving gifts is not always easy to make. Illegal and unethical practices include, for example, buying medical certificates, bid rigging during procurements, or selecting service-providers for a hospital based on personal connections. A conceptual global definition of informal payments in health care is not feasible because informality depends on local regulations, values, and traditions. In this chapter, we provide an up-to-date understanding of informal payments in health care (including corruption, fraud etc.) by distinguishing micro, meso, and macro levels of informal payments. We argue that informal payments that occur at these levels cannot be unified under one umbrella of corruption because the various forms of informal payments in health care differ in nature, scope, and damaging effects.