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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.

Based upon estimates of the change in consumption due to a change in out-of-pocket-health expenses (dC/dOOPHE) for 43 countries, this paper aims to argue for a reevaluation of what constitutes OOPHE when determining health insurance especially in the wake of Covid-19.

Reiterative truncated projected least squares (RTPLS), a statistical technique designed to handle the omitted variables problem of regression analysis.

If budgets are binding than dC/dOOPHE should be 0; if OOPHE merely adds to current consumption than dC/dOOPHE should be 1. However, merely plotting consumption versus OOPHE for the 43 countries for which organization for economic cooperation and development has the required data clearly shows a dC/dOOPHE much greater than one. This paper’s estimates of dC/dOOPHE for 2000 to 2017 range from 15.6 for Switzerland (in 2016) to 225.2 for Columbia (in 2003).

RTPLS cannot determine what part of the results are due to an increase in income causing both consumption and OOPHE to increase and what part is because of actual OOPHE far exceeding official OOPHE. However, the latter is involved.

As Covid-19 sickens millions while depriving millions of their normal means of generating income, what constitutes OOPHE should be expanded when determining health insurance. This paper’s results imply that even prior to Covid-19 health insurance covered much less than the optimal amount of actual OOPHE.

This is the first paper to use RTPLS to estimate dC/dOOPHE.

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.

Health improves the proficiency and output generated by individuals. It also raises physical as well as mental abilities, which are required for the growth and advancement of any economy. Many infant diseases have been recognised via contemporary technology in a bid to tackle these diseases. However, children within the African continent (Including Nigeria) die en masse from diseases. This has made the government of Nigeria allocate sizeable part of the nation's budget to healthcare system. The allocation to health is, however, yet to translate to improved health condition for Nigerians. It does not measure up to the World Health Organization's (WHO) standards for apportioning budget to the health sector. This study also analyses empirically the impact of healthcare expenses on the mortality level of infants as well as Nigeria's neonatal mortality level.

The paper focuses on Nigeria. Vector auto regression model techniques, unit root tests and cointegration test were carried out using time series date for the period between 1986 and 2016.

The outcome has revealed that expenditure on healthcare possesses a negative correlation with the mortality of infants and neonates. The study discovers that if the Nigerian government raises and maintains health expenditure specifically on activities focused on minimising infant mortality, it will translate to reduction in infant mortality in Nigeria.

This paper has contributed exhaustively to solution to poor expenditure on healthcare, especially child mortality, in Nigeria.

This paper describes major trends in the health care market. They include increased health care costs, the growth of managed care, emphasis on quality of care, consumer choice and the growth of the elderly and uninsured populations. The relationship between cost, quality, managed care and choice are explored in the Medicare and Medicaid programs. A clearer understanding of these trends enables managers in health care organizations to make strategic decisions resulting in organizations' survival and growth.

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.

How is migration related to informal activities? They may be complementary since new migrants may have difficulty finding employment in formal work, so many of them end up informally employed. Alternatively, migration and informality may be substitutes since migrants’ incomes in their new locations and income earned in the home informal economy (without migration) are an imperfect trade-off. Tajikistan possesses both a very large informal sector and extensive international emigration. Using the gap between household expenditure and income as an indicator of informal activity, we find negative significant correlations between informal activities and migration: the gap between expenditure and income falls in the presence of migration. Furthermore, Tajikistan's professional workers’ ability to engage in informal activities enables them to forgo migration, while low-skilled nonprofessionals without postsecondary education choose to migrate instead of working in the informal sector. Our empirical evidence suggests migration and informality substitute for one another.

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.

The purpose of this paper is to quantify the impact of socio‐economic characteristics on out‐of pocket expenditures for prescribed medications in Tajikistan and provide recommendations for healthcare sector reform. The research question in this paper is: what household, personal, economic, and health factors help explain expenditures on medications? From a theoretical perspective, this paper contributes to the on‐going discussion of out‐of‐pocket expenditures in Tajikistan. From a practical perspective, in line with this recent development in the Tajikistan healthcare sector, it helps to develop evidence‐based decision‐making by answering practical questions: what factors affect pattern of out‐of‐pocket expenditures for prescribed medication? Which groups of the population should be granted a discount or fee‐waiver when buying them?

Based on micro‐file data from the most recent cross‐sectional nationally‐representative survey of Tajik households, this paper develops and tests a multivariate model of identifying determinants of out‐of‐pocket expenditures on prescribed medications in Tajikistan.

The paper finds that economic status, chronic illness, disability, number of small children, short supply of necessary drugs, and cardiac and acute illnesses are the strongest determinants of spending for prescribed medications in the country.

This paper demonstrates that to ensure accessibility to and affordability of prescribed medications, discounts or fee‐waivers should be granted to specific categories of households, those in poverty, with chronically ill members and with small children. These discounts or fee‐waivers should cover prescribed medications for children, long‐standing illness as well as for cardiac and acute infectious diseases. Administrative and economic measures should be taken to reduce the extra costs incurred due to the shortage of prescribed medications. Hence, these findings can be used in developing and designing reforms in the Tajikistan healthcare sector.