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The impact of income on health expenditure has been studied extensively using national-level data; however, studies estimating the household-level income elasticity of health expenditure, particularly by provider types, remain limited. Analysing nationally representative household survey data, we examine outpatient and inpatient out-of-pocket (OOP) expenses across healthcare providers and by various income levels. We employed the Heckman two-step model and OLS regression to estimate income elasticity separately for outpatient and inpatient services. Our findings indicate that income elasticity varies significantly by service type, provider, and income level. Outpatient care at private facilities is a luxury good for the lower-income households, while outpatient expenses for public and informal outpatient care providers remain inelastic across income levels. Private inpatient care is also income inelastic, whereas public inpatient care shows non-uniform elasticity. Overall, lower-income households showed greater elasticity than wealthier ones. The results imply, during income shocks, poorer households switch to cheaper public and informal care. Inpatient care is prioritised over other expenses, increasing the risk of poverty among low-income households. The study suggests the dire need for financial protection measures, particularly for low-income groups, as OOP health expenditure often becomes catastrophic for those households. In addition, higher income resulting from economic growth will increase the demand for private outpatient services, suggesting quality improvement for public health facilities as well as the importance of adapting healthcare policies to evolving income dynamics., (© 2024 John Wiley & Sons Ltd.)

Background: Low- and middle-income countries worldwide are striving to achieve universal health coverage (UHC), frequently through expansion of statutory health insurance schemes. However, oftentimes evidence is lacking on progress towards quality patient-centred care and out-of-pocket expenditure (OOPE), particularly for poor population groups. We contribute patient-centred evidence examining patient experience and OOPE under JKN, the Indonesian social health insurance., Methods: Using data from 2526 patient exit interviews conducted among JKN beneficiaries in 2015, we computed a summative patient experience measure from 14 experience items. We used descriptive statistics to assess patient experience and the probability, amount and components of OOPE. We applied a two-part model to examine the relationships between socio-demographics, facility types, and OOPE and an OLS regression on patient experience determinants., Results: The mean patient experience measure was 11.7 out of 14 maximal points. Differences were observed between single items, with highest ratings on ease of understanding providers' language (97%) and lowest on waiting time (54%). OOPE were reported by 20% of patients with a mean equivalent to US$40, the most prevalent reason being medicines (61% of all OOPE). Considerable OOPE heterogeneity occurred by province and facility type. We found differentials in OOPE by gender (females paying more likely, but less) and subsidised JKN membership (same likelihood as non-subsidised, but paying less)., Conclusion: Our findings suggest that during its early implementation, patients under JKN reported mostly positive patient experience yet a fifth incurred OOPE, mostly on medicines. Further patient-centred research is needed to ensure JKN's progress towards UHC., (© 2022 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Introduction: The high share of out-of-pocket (OOP) health expenditure imposes an extreme financial burden on households, and they have to incur a substantial amount of expenditure to avail health care services. This study analyses the inter-state differentials in the economic burden of OOP health expenditure, resultant impoverishment impact, and sources of finance used as coping mechanisms., Materials and Methods: The study is based on health expenditure survey, namely the 71 st Round on "Key Indicators of Social Consumption in India: Health," (2014) conducted in India by the National Sample Survey Organisation. The study uses headcount, payment gap, and concentration index to measure the economic burden, impoverishment impact of OOP health expenditure, and the level of inequality., Results: On the basis of results, the states can be divided into four distinct categories: (1) States with low economic burden and low poverty impact of OOP health expenditure, (2) low economic burden and high poverty impact of OOP health expenditure, (3) high economic burden and low poverty impact of OOP health expenditure, and (4) high economic burden and high poverty impact of OOP health expenditure., Conclusions: Inter-state differentials in OOP health expenditure and impoverishment need proper attention of the government especially the policy makers., (© 2018 John Wiley & Sons, Ltd.)