Out-of-pocket expenditures associated with double disease burden in Pakistan: a quantile regression analysis

Area of Science:

• Public Health
• Health Economics
• Epidemiology

Background:

• Pakistan grapples with a dual burden of communicable and noncommunicable diseases.
• Households with members affected by both disease types face significant impoverishment risks due to high out-of-pocket (OOP) payments.
• Understanding the determinants of OOP expenditure in this context is crucial for financial risk protection.

Purpose of the Study:

• To examine the percentile distribution of determinants influencing out-of-pocket expenditure.
• To analyze the association between socioeconomic factors and OOP spending related to the double disease burden in Pakistan.

Main Methods:

• Utilized data from 6,775 households experiencing both communicable and noncommunicable diseases from the Household Integrated Economic Survey 2018-19.
• Employed quantile regression to analyze the association between socioeconomic factors and OOP expenditure.
• The dataset was cross-sectional and nationally representative.

Main Results:

• 28.5% of households reported a double disease burden in 2018-19.
• Factors like uneducated household heads, male heads, outpatient care, public sector service utilization, rural residence, and older members were associated with the double disease burden.
• Increased communicable and noncommunicable diseases were linked to higher monthly OOP expenditure in lower percentiles, while older members increased OOP expenditure in higher percentiles.

Conclusions:

• The co-occurrence of communicable and noncommunicable diseases leads to substantial private healthcare costs in Pakistan.
• There is a need to address the varying financial burdens associated with managing the double disease burden.
• Policy interventions should consider the differential impact of socioeconomic factors on OOP expenditure across different expenditure levels.