RESUMEN
Despite the free public healthcare policy in Sri Lanka, households' out-of-pocket healthcare expenditures are steadily increasing. Parallel to this, there is an emerging private healthcare sector based on a user-pays approach. This study, therefore, examines the relationship between healthcare utilization and out-of-pocket healthcare expenses at household level. Using a double-hurdle model with 42,288 household observations drawn from the household income and expenditure survey (2012/2013 and 2016 waves), we find that out- and in-patient care in public hospitals under 'free healthcare policy' is positively associated with household out-of-pocket healthcare expenses, imposing a significant financial burden on the family budget. This relationship is even greater for utilization of private out- and in-patient care. The recent regulatory and fiscal interventions of the government have favourably moderated this relationship for out-patient care but not for in-patient care. The results recommend introducing public policies to further strengthen the monitoring process for private healthcare sector while ensuring the sustainability of free healthcare policy. The paper provides policy implications for richly categorized out-of-pocket healthcare expenditure and healthcare utilization types.
Asunto(s)
Gastos en Salud/normas , Política de Salud/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Política de Salud/tendencias , Humanos , Renta/estadística & datos numéricos , Sri Lanka , Encuestas y CuestionariosRESUMEN
We investigate the effects of experiencing non-communicable diseases (NCDs) on labour force outcomes of working-age individuals and their households in Sri Lanka. For this, quasi-experimental evidence, including average treatment effects on those treated (ATT), are generated by using the self-reported health survey of the labour force of Sri Lanka. According to the analysis, individuals with at least one NCD account for approximately 19.15% of the working-age population. On average, employment probability, labour supply, and labour earnings of them are significantly lower than those of non-NCD individuals by 9.5% (ATT=-0.102, Pâ¯<â¯0.001), 44.6% (ATT=-0.590, Pâ¯<â¯0.001), and 47.9% (ATT=-0.652, Pâ¯<â¯0.001), respectively. The negative impacts on labour force outcomes are notably larger in the cases of paralysis and mental illness. These NCDs reduce individual labour supply by more than 80% and labour earnings by more than 90%. The employment probability of individuals with paralysis and mental illnesses is also relatively lower by more than 60%. Apart from these individual-level effects, the paper provides evidence on how labour force outcomes at the household level are influenced by NCDs. Our findings demonstrate that the association between individuals' NCD-prevalence and labour force outcomes is relatively stronger for males, informal sector employees, and elderly people. The results suggest several social inclusion policies.
Asunto(s)
Empleo/estadística & datos numéricos , Renta/estadística & datos numéricos , Enfermedades no Transmisibles/epidemiología , Adolescente , Adulto , Anciano , Epilepsia/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Neoplasias/epidemiología , Parálisis/epidemiología , Prevalencia , Factores Socioeconómicos , Sri Lanka/epidemiología , Adulto JovenRESUMEN
With significant increases in chronic non-communicable diseases (NCDs) in recent years, Sri Lanka has witnessed a growing trend of increased out-of-pocket payments for healthcare, imposing a severe burden on household budgets. This is exacerbated by limited government health funding and inadequate financial security from formal social security. We examine the association of NCD-prevalence and healthcare utilization with household consumption, using the most recent Sri Lanka Household Income and Expenditure Survey 2012/2013. The unit of analysis is the household. We use data for 20,535 households to apply two-part models. Findings suggest that financial constraints induced by NCD-prevalence and hospitalization compel households primarily to sacrifice food consumption. Analysis further shows that poorer households are more vulnerable to food insecurity arising from these. Households sacrifice the basic needs of housing and clothing, and the burden on poorer households is higher, whereas richer households have the option of sacrificing more from non-basic needs to cope with NCDs and hospitalization and thereby to secure basic needs to a certain extent. Moreover, the burden of out-of-pocket healthcare expenses is found to be positively associated with NCDs and hospitalization. In addition to the direct association, public hospitalization favorably moderates the associations between NCDs and the allocations for food and healthcare. Private hospitalization is adversely associated with a wider range of consumption, creating negative welfare consequences. These findings provide valuable information on what needs to be done to reform Sri Lanka's health sector. The study contributes to international discussions on frameworks and national-level policies for effectively allocating public and private funds to the health sector to mitigate hardships faced by the poorest households.
Asunto(s)
Costo de Enfermedad , Composición Familiar , Gastos en Salud/estadística & datos numéricos , Enfermedades no Transmisibles/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización/economía , Humanos , Renta/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza , Sri Lanka/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
This article examines patterns and determinants of the likelihood and financial burden of encountering out-of-pocket healthcare expenses in Sri Lankan households as, on average, more than 60% of households incur such costs. This percentage varies substantially across household categories in demographic properties, sectors and ability-to-pay. Households comprising more than one elderly person, pre-school children, members with chronic illnesses, and literate household heads are at significant risk of incurring out-of-pocket payments and bearing a higher financial burden. Rural and estate sector households are more likely to bear a higher burden. The marginal effects of household income show that the burden of private healthcare is less sensitive towards changes in household income and that households' burden in private healthcare was regressive in 2006/2007. Hence results imply that low-income households need to be protected. Analysis of supply side factors shows that availability of closer government hospitals, bed numbers and dentists in government hospitals reduce the burden of out-of-pocket expenses. However, more government doctors lead to higher likelihood and burden of incurring such healthcare expenses and create a government-doctor-induced cost. Therefore, the results show a convincing need for the expansion of healthcare infrastructure by government and a policy framework for its doctors that will lessen the financial burden in Sri Lankan households, particularly the poor.