Household Narratives on Out-of-Pocket Health Expenditures in Pakistan

The critical issue of health financing in developing economies has become an immediate concern, with low public spending on health and limited insurance coverage compelling households to pay through out-of-pocket (OOP) expenditure. Although the financial burden associated with OOP spending has been quantified in other studies, there little is known about the experiences households go through and how they cope with them, especially in South Asia. The aim of this research was to fill this gap by analyzing household accounts on out-of-pocket (OOP) health spending in Pakistan in terms of prevalence, reasons, and socioeconomic consequences, in particular, catastrophic spending. A mixed-methods research design was used that incorporated both quantitative and qualitative data by using 50 households representing a cross-sectional study and a semi-structured interview. Mann-Whitney tests, chi-square tests, Kruskal-Wallis tests, logistic regression, ordinary least squares regression, and Spearman correlations were used to analyze data. The results have shown that 42 percent of households experienced catastrophic expenditures on health, and rural families (52 percent) were much more affected than the urban ones (35 percent, z = 2.09, p = 0.037). The highest concentration of the catastrophic spending was observed amongst the poorest quintile (80 percent), and none were found in the wealthiest (p = 0.004, Cramer. V = 0.46). The insurance substantially lowered the chances of catastrophic spending (OR = 0.20, p = 0.018), but chronic illness (OR = 2.51, p = 0.027), health shocks (OR = 4.39, p = 0.007), and use of private facilities (OR = 2.86, p = 0.021) showed a marked increase in vulnerability. Borrowing, taking debt, and decreased food or education spending were the coping mechanisms closely associated with increased OOP (p < 0.01, 0.41). In the concluding part, the research showed that OOP health expenditure subjects households to high financial risks, especially the vulnerable populations. These results present compelling arguments for the policy changes that encourage financial security and equal access to health care.