DETERMINANTS OF OUT-OF-POCKET EXPENDITURE FOR HEALTH CARE: A SYSTEMATIC REVIEW

Background: Out-of-pocket (OOP) expenditure is a cost for health care that are paid by individuals at the time of treatment through user fees, co-payments and direct payments. It is the most common way of paying for health services in developing nations particularly in low and middle-income countries. OOP payments are typically perceived to be the most regressive instrument of health finance and high reliance to it create a significant financial barrier in accessing health care. Objectives: To assess the determinants of OOP expenditures for health care. Materials and Methods: Journal and articles related on determinants of OOP health expenditures were compiled using a major online database, PubMed and Science Direct. The search was limited to full-text papers published in English and studies conducted within the last 10 years (2007-2017). The selection of articles to be reviewed is done according to the PRISMA checklist. Result: The main determinants of OOP health expenditure identified were age, gender, place of living, education and income level, household size and presence of comorbidities. Other determinants were marital status, insurance status, payments for medical supplies and pharmaceuticals and distance to health facilities Conclusion: OOP payments is not an equitable nor efficient financing mechanism. A government need to formulate the best health financing mechanism to achieve a complete universal health coverage status. This review can help policy-makers in identifying the determinants of OOP, focussing on the mechanisms driving them, and formulate policy options for building stronger health financing mechanisms. Keywords: Determinants, Out-of-Pocket, Expenditure, Health Care