Determinants of household healthcare expenditure an analysis in vietnam by using of VHLSS 2006

Householdcha rac ter is ti cs and healthcareexpenditure 46Communitycharacteristicsand healthcareexpenditure 54... Figure4.3 HouseholdHealthcareexpenditurestructureinyear2006 45V.N... The

UNIVERSITYOFECONOMICSHOCHI MINHCITYVIETNAM

INSTITUTEOFSOCIALSTUDIES

THEHAGUETHEN

E T H E R L A N D S

VIETNAM-NETHERLANDS PROGRAMMEFORM.AINDEVELOPMENTECONOMICS

L o a n fort h e continuoussupportofm y studyandresearch,forh e r patience,motivation,enthusiasm,andimmenseknowledge.Herguidancehelpedmeinallthetimeofresearchandwritingofthisthesis.Andmysincerethanksalso

gotoAssociateP r o f e s s o r D r NguyenT r o n g Hoai,Co-Directoro f TheNetherlandsProgramforM.A.inDevelopmentEconomics,whohasalwaysgivenmehisencouragementsandkindlyduringthecourseofmystudyandthesisresearch

Vietnam-Iw i s h t o t h a n k m y c l o s e f r i e n d , P h a m T i e n T h a n g , w h o s u p p o r

t e d m e i n findingworkingpapersforreferences

Lastly,Iowemylovingthankstomyparentsandmyhusband.Withouttheirencouragementandunderstanding,itwouldhavebeenimpossibleformetofinishthiswork

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Themainpurposeo f thiss t u d y i s toi de nt if y t h e d e t e r m i n a n t s o f householdhealthcaree x p e n d i t u r e i n Vietnam.T h e mains o u r c e da t a for thea n a l y s i

s arefromVietnamHouseholdLivingStandardSurvey2006(VHLSS2006).TheanalysisusesstatisticanalysisandOrdinaryLeastS q u a r e s (OLS)estimatestofindoutthedeterminantsofhealthcareexpenditure.First,statisticanalysisgivesusanoverview

ofhouseholdh e a l t h c a r e e x p e n d i t u r e si t u a t i o n i n Vietnam.S e c o n d , weestimatetheparameterso f householdhealthcare e x p e n d i t u r e modelbyusingtheOrdinaryLeastSquares(OLS)estimates

Thes t a t i s t i c r e s u l t s i n d i c a t e t h a t i n t h e t o t a l o f h o us e h o l d e x p e

n d i t u r e , t h e householdh e a l t h c a r e e x p e n d i t u r e m a d e u p o n l y 6 3 7 %

a n d i n t o t a l o f h o u s e h o l d

healthcareexpenditure,72.530isusedinpayinguserfeesathealthfacilities(healthexpenditureforhavingtreatment).Theresultsalsopresentthathouseholdhealthcareexpendituresd i f f e r b y e x p e n d i t u r e q u i n t i l e s , h e a l t h s t a t u s , h e a l t h i n s u r a

Keywords:households;healthcareexpenditure,householdexpenditures,Vietnam

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TABLEOFCONTENTS TABLEOF CONTENTS ACKNOWLEGEMENTS

1.3Rese arch questions

2.1 Definitions2.1.1 Healthcare

2.1.2 HouseholdH e a l t h c a r e e x p e n d i t u r e

Theoreticalf r a m e w o r k forHouseholdH e a l t h c

a r e2.2ExpenditureF u n c t i o n

2.2.1 Householdsandutilizationofhealthcare

Householdcharacteristicsandhouseholdhealthcare

2.2.2

expenditureCommunitycharacteristicsandhouseholdhealthcare22

expenditure

AnoverviewoftheEmpiricalstudiesrelatesto

2.3householdh e a l t h c a r e expenditure

Page3

4

589

1011

111415

17

1717181818

20

2223

Householdcha rac ter is ti cs and healthcareexpenditure 46Communitycharacteristicsand healthcareexpenditure 54

Determinantso f householdhealthcareexpenditure.•AnanalysisinVietnamusingofV H L S S 2tI#6

Regressionresultsofthedeterminantsofhousehold

64

healthcareexpenditureswithsignificantvariables

Figure4.3 HouseholdHealthcareexpenditurestructureinyear2006 45

V.N

Thebest model:RegressionofthemodelwithdependentAppendix5 79

variableisHouseholdpercapitahealthcareexpenditure

hadtoborrowtopayforhealthservicesandth e burdeno f healthe x p e n d i t u r e h a s resultedi n borrowingsb y m a n y households.Thef i n a n c i a l b u r d e n ofh e a l t h c a r

e alsoc a u s e s a n e n d l e s s c y c l e o f povertya n d ill-health- theburdeno f of-pocketh e a l t h c a r e paymentso n households

out-The“doimoi”(renovation)processofVietnamstartedin19 86 andafterover20y e a r s o f “ D o i m o i ” , V i e t n a m h a s g a i n e d s i g n i f i c a n t a c h i e v e m e n t

s i n b o t h t h e economyandsociety,includingimportantachievementsinHealthsector

Thehealthreformshavereachedprofoundchangesinhealthcareutilizationincludingthechangeinh e a l t h c a r e financing,h e a l t h c a r e access,h e a l t h c a r e delivery.M o r e

a t t e n t i o n t o promotethedevelopmentoft h e privatehealthsectorandliberalizationo f t h e pharmaceuticalindustrya r e t w o o f t h e m o s t i m p o r t a n t r e f o r m s i

n h e a l t h s e c t o r s Beside,t h e userf e e s forhealths e r v i c e s athigherl e v e l publiche al th f a c i l i t i e s a n d healthinsuranceprogramalsoh a v e introduced.Alloft h

e s e reformshavehad

t f o r h e a l t h c a r e expenditures.T h e h e a l t h i n s u r a n c e f u n d c o v e r s c u r a t i v e

c a r e e x p e n d i t u r e s f o r t h e

peoplethatenrolledinsocialhealthinsuranceschemes(compulsorya n d voluntary).Besides,t h e g o v e r n m e n t a l s o i s s u e s s o m e health i n s u r a n c e p o l i c i e s t h a t

e x p a n d e d subsidizedh e a l t h i n s u r a n c e t o c o v e r t h e p o o r , t h e n e a r p o o r a n d

c h i l d r e n u n d e r 6 yearsold

Andt h e V H L S S 2 0 0 6 ’ s r e s u l t s s h o w t h a t m o r e t h a n 50%p e o p l e

r e c e i v i n g medicalexaminationandtreatmenthadhealthinsurance,significantincreasethantheratei n 2 0 0 4 e v e n i n r u r a l a r e a s H o w e v e r , coverageo f h e a l t h i n s u

r a n c e r e m a i n s limited;t h e f i n a n c i a l s u s t a i n a b i l i t y o f h e a l t h i n s u r a n

c e f u n d i n g i s s t i l l l o w R u r a l peopleh a d l e s s opportunity t o r ec e i v e m e d i

c a l e x a m i n a t i o n a n d treatment i n s t a t e hospitalsthanurbanpeople;theyoftenhad

togotocommunehealthcenters.Therateinr i c h e s t q u i n t i l e w a s h i g h e r t h a n i n t h

e p o o r e s t q u i n t i l e a n d t h e d i f f e r e n c e w a s patients.Differencesinutilizationofhealthservicesbetweenvariouspopulationsgroupshavegrown,itcoupledwithgapsinlivingstandard.AlsoaccordingtotheVHLSS2006’sresults,expenditureforhealthcareofhouseholdsin2006wasa l l increased t h a n in 2004.Theaverage expenditurep e r pe r s o n o f urban

richhouseholdswashigherthanofr u r a l householdsandp o o r householdsrespectively.InVietnam,healthcareexpendituresofthepoormakeupahigherp r o p o r t i o n o f theiri n c o m e t h a n t h e non-

poore v e n thought h e y o f t e n t r y torestricttheirseeking-behavior

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Moreover,thereportbytheWorldBank(2001)indicatedthatthereisaverylargeinrelationtodisposableincomeforthepoor.T h i s isabigproblemofthehealthsectorespeciallyindevelopingcountries.Theexpenditureforhealthcareservicesistoohighf o r thepoora n d m a n y p e o p l e d o e s notc o n f i d e n c e i n theq ua l i t y o f localmedialcareservicesmaycauset h i s p r o b l e m Therefore,understandingwhich

s u c h a s h o u s e h o l d e c o n o m i c s i t u a t i o n s ( i n c o m e , w e a l t h ),

householdc o m p o s i t i o n s ( a g e , gender,thenumbero f males/females,t h e numbero f children,h o u s e h o l d s i z e ),communityc h a r a c t e r i s t i c s ( r e g i o n ,

r u r a l /

u r b a n )andtypeo f d i s e a s e s I n V i e t n a m , therea r e f e w s t u d i e s t h a t r e

s e a r c h onh e a l t h careexpenditure.T r i v e d i (2002)hasstudiedthemajorf e a t u r

e s ofhealthcareutilizationpatternsinVietnam.Thestudyfocusedon“thedeterminantsoflargelyself-

prescribed,theuseofpharmaceuticald r u g s , governmenthospitals,commune healthcenters,a n d p r i v a t e h e a l t h f a c i l i t i e s ” H e a l t h i n s u r a n c e a n d h o u s e h o l

d i n c o m e a r e considereda s the i m p o r t a n t f a c t o r s t h a t e f f e c t o n health c a r e

e x p e n d i t u r e B e s i d e , seekingbehaviorofhouseholdstochoicehealthcareprovidertypesisalsoanalyzedinthestudy.By

usingregressionmethod,theeconometricmodelsanalyzehealthcareexpenditureinbothindividuala n d householdl e v e l Inanotherstudyonhealthcare expenditureinVietnam,CCSE—WHOgroupandMinistryof

Healthgroup(2006)pointedo u t manyf a c t o r s thathadim pac t oncatastrophic h

ea lt hca re e x p e n d i t u r e i n Vietnam Thesefactorsconsist:“householdlivingstandardstatus,householdincome;

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educationlevelofhouseholdhead,ethnicstatus,numberofinpatientvisits,numberof

o u t p a t i e n t v i s i t s , n u m b e r ofo v e r c o u n t e r v i s i t s f o r s e l f

-t r e a -t m e n -t , n u m b e r ofchildren,numberoffer-tilefemaleandnumberofelderlypersonsin household,etc”.Andtherolessocialinsuranceandtargetsubsidiestothepoorinreducingtherateofhouseholdcatastrophichealthexpenditurearealsoprovedintheresearch

However,whilem a n y decisionsa r e h o u s e h o l d decisions,

i o n isthemaindatasourceusedforregressionthemodel.Besides,thedatafromtheMinistryofHealthreportsisalsousedfordescriptiveanalysisinthispaper

1.2Objectiveso f thestudy

Theaimofthispaperistoinvestigatethefactorsthatmayhaveinfluenceon household

healthcareexpenditureinVietnam.Morespecifically,thisstudyattempttoexplorethefollowquestions:

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- Whichfactorsdeterminehouseholds’healthcareexpenditureinVietnam?

- Whatextentsignificantdeterminants impactonhealthcareexpenditure?

- Isthereadifferencebetweenthehealthcareexpenditurepatternsofpoorhouseholdsandthose ofbetter-offhouseholds?

Knowingtheanswerstothesequestionsisveryimportant forpolicym ake rs, thesec a n h e l p t h e m i n m a k i n g i n f o r m e d d e c i s i o n s r e g a r d i n g p o l i c i e

s i n t e n d e d t o improves o c i a l welfare F o r e x a m p l e , f o r thehouseholds t h a

t t h e y a r e l a c k o f t h e abilitytospendmoreforhealthcare,thegovernmentshould provideonlyverybasichealthcareatlowprice.However,forthehouseholds

thattheyhavetheabilityandthewillingnesstospendmoreonhealthcarea n d theyreadypayfor goodquality healthcare,thenthegovernmentc a n expandmoreoptions.Byofferingawidervarietyo f healthservices,thegovernment

-Whatt h e G o v e r n m e n t shouldd o tor ed uce

financialb u r d e n o f healthcareexpenditure forthepoor?Theresultsofthisresearchmayhelp

theplannersgiveaneffectivehealthcarepolicythatreducetheburdenofhealthcareexpenditureforhouseholds,especiallyforthepoor

D et e r m in a nt s o f householdh e a l t h c a r e i n Vietnam,byusingthedescriptivemethodandregressingtheeconometricmodel,itanalysesoverviewhouseholds’healthcareexpenditureandexaminesdeterminantsofhouseholds’healthcareexpenditureinVietnam;Andfinal,ChapterV—

ConclusionandRecommendations,thischapters u m m a r i z e s allanalysis

andfindingsinpreviouschaptersandgivessomepolicyrecommendations

Appelbaum(1999)saidthat:“healthcaremeansanycare,treatment,orprocedurebyahealthcareprovider:

- Anymedical,surgical,obstetricalordentaltreatment,and

- Anythingdonethatisancillarytoanyprocedure,t r e a t m e n t , ex a m i n a t i o n ordiagnosis”

Insomestudies,theauthorsmentionedaboutaccessfactorsthatmayinfluencetoutilizationofhealthcare.I n reality,thelargestdeterminantofseekingcaremaybetheexpectedaccesscostandtheindividualoftentakethe

firstcontactwiththesystemhealthcare.L e 5 Grand(1982)arguesthataccesscostincludesbothm o n e t a r y c o s t s andtimecosts,itconsistssomefactorssuchasoutofpocketpayments, d i s t a n c e tohealthfacilities,waitingtimeatthefacilityetc,i.e.Morespe

fortravelingtothehealthfacilities,whiletimecostsi nc lu de t i m e toreacht h e f a c i l i t y ,

w a i t i n g t i m e a t thef a c i l i t y a n d timetogetadvicefromthehealthconsultants.Accesscostsareusuallyanimportantdeterminantofhealthcareutilization,especiallyitismoremeaninginanalyzingthedifferencesinhealthcareutilizationacrossdifferentsocialgroupsindevelopingcountries(GentlerandvanderGaag,1990)

Jacobson( 2 0 0 0 ) arguesthattheindividuald o e s notproduces“ g o o d he al

t h”, “goodhealth”is producedbythef a m i l y T h e r e f o r e , theGrossman’smodel

isextendedintoanewmodel withtheproducero f healthi s thefamily.Withthenewmodel,J a c o b s o n ( 2 0 0 0 ) c o n c l u d e d t h a t t h e p r o d u c t i o n o f healthn o t o n l

y u s e t h e

individuals’ownincomebutalsot h e family’scombinedresources.Thefamilyallocatethei nv est men ts i n healthc a p i t a l a n d i t willn o t t r y t o distribute t h e eq u a l healthc a p i t a l t o e a c h m e m b e r o f t h e f a m i l y T h e r e f o r e , i t l e a d s t o t h e

m a r g i n a l

childrenandthehouseholdwithchildren.Thehouseholdwithchildrenw i l l allocatea l a r g

e r

s h a r e o f t h e b u d g e t t o foodt h a n householdsw i t h o u t c h i l d r e n A naturalp

a r a l l e l t o householdh e a l t h e x p e n d i t u r e , i t wouldbethathouseholdswithchildrenallocatealargershare

a x i m i z e a householdl e v e l welfaref un ct io n” andtherefore,theutilityfunctionisajointu t i l i t y function.A l l a v a i l a b l e r e s o u r c e s o f thehousehold a r e pooleda n d

9 9 0 , Boline t al,1999).Moreover,t he re aresomeothermodelshavebeens u g g es t

e d , Behrmane t al(1982;1986)s u g g e s t t h a t m o d e l i n g i n t r a h o u s e h o l d allocationsshoulda s s u m e a specificstructureforparentalpreferences,whileothersproposethat aParetoefficient

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outcomes h o u l d beused( C h i a p p o r i , 1 9 8 8 ; Kooreman,

1990).WhiletheBeckerianmodelpoolallresources,theseabovemodelallowthedifferencesbetweenhouseholdmembersi n preferences,r e s o u r c e s are allocatedtowardsgoo

ds thatdifferenthouseholdmembersdesire

ThenextmodelthatwereviewhereisoneofthesimplestmodelsofhouseholdconsumptionofSamuelson(1956).Itassumedthat“thehouseholdi n c o m e alwaysisdividedinpre-specifiedp ro po rt io ns betweenhousehold me mbe rs” Eachhouseholdmembermaximizesutility s u b j ec t tothegivenbudgetconstraint bychoosingherorhisownconsumptionb u n d l e Ap pl yi ng t h i s forheathcareexpenditure,we see that

eachh o u s e h o l d m e m b e r w o u l d t r y t o g e t h e r o r h i s o w n u t i l i t y o f h e a l

t h c a r e consumptiona n d n o t t h e b e n e f i t s f o r t h e h o u s e h o l d asa u n i t T h e

r e f o r e , f o r t h e householdt h a t d o n o t h a v e c o m m o n p r e f e r e n c e s , B a r g a i

n i n g m o d e l s f r o m cooperativegametheorymaybethebestchoiceinthissituation.Lundberg

andPollak(1996)haduseNashbargainingmodelsfortheirresearch.However,theexperiencesindicatethatthesemodelsareonlysuitableinatwo-personhousehold

Mores p e c i f i c a l l y , a l m o s t themodelsa b o v e mentions o m e mainf a c t

multiplesickmembersfac e decidingwhototreatthroughinpatientcareandwhototreatthroughothermethods.Thethreealternative-

specificvar ia bl eseac h reflectthecostsa n d b e n e f i t s a s s o c i a t e d w i t h t r e a

t m e n t a t e a c h t y p e o f f a c i l i t y ; p r e s u m a b l y , lowerm i n i m u m spendingt h r

e s h o l d s , higherm a x i m u m benefitlevels,a n d l o w e r averagecostsoftreatmentincreasetheattractivenessofeachhospitaltype.Moreover,someo th er f a c t o r thatl i k e l y i n f

l u e n c e b o t h t h e d e c i s i o n t o s e e k c a r e a n d hospitalchoicesuchasage,sex, disabilities,a n d emigration s t a t u s For e x a m p l e , w h e n g e t sick,womenaremorelikelytoseekcareforsicknessthanmenintheU.S.andChinarespectively( G a o andYao2006).Similarly, Reinhardt( 2 0 0 0 ) revealsthatagehavepositiveimpactonboththequantityofhealthcareexpenditureandtotalspending.Thedisabledaremorelikelytoseekhealthcarethanpeoplewithoutphysicall i m i t a t i o n s (Sommers2 0 0 6 -

2 0 0 7 ) B y c o n t r a s t , people w h o e m i g r a t e have b e t t e r s e l f

-r e p o -r t e d healthstatusandlowe-rincidenceofillness(Heskethetal.2008),suggestingthattheymayhavedifferentpreferencesforhealthcarethannon-migrants

2.2.3Communitycharacteristicsa n d householdhe a lt h c ar e e x p e n d i t u r e -

Final,we m e n t i o n a b o u t s o m e l i t e r a t u r e s o f c o m m u n i t y c h a r a c t e

r i s t i c s a n d householdh e a l t h c a r e e x p e n d i t u r e O b v i o u s l y , e a c h r e

g i o n h a s d i s t i n c t f e a t u r e s o f geography,d e m o g r a p h y , a n d c u s t o m s o tha

tt h e h o u s e h o l d h e a l t h c a r e e x p e n d i t u r e livingindifferentregionsalsoaredifferent.Placeofresidence,forexample,whetheronelivesinaruraloranurbanarea,mayindicategeographicproximitytoasourceof

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Inshort,consumptionbehaviordependsondemographicandsocio-economicstatuses.Fromtheabovediscussionoftheories,weseethathealthcareutilizationmaybea f f e c t e d n o t o n l y b y t h e h o u s e h o l d composition(sucha s h o u s e h o l dsize,t h e numberofadultfemales,males,thenumberoffertilewomenandchildren

withinthehousehold)butalsoi n d i v i d u a l characteristicsofh o u s e h o l d members,householdhead’scharacteristic.S o m e importantdeterminantsofhealthcareutilizationrelating tothehouseholdhead’scharacteristicsareEducationlevelofhouseholdhead,sexofhouseholdhead,ageofhousehold(Himanshu,2006).Besides,regionswithdifferentsocio-

economicc o n d i t i o n s a l s o havei m p a c t o n householdh e a l t h c a r e e x p e n d i t

u r e (Margheritaa n d Theodore,2002;Hanguyen,PeterandUlla,2002) Moreover,t h e residentplaceofhousehold(rural/

urban)isanimportantfactorthatmayhaveimpactonhouseholdhealthcareexpenditure(Woottipong,2001)

2.3 AnOverviewo f theEmpiricalstudiesrelatestohousehold

healthcareexpenditure:

Therea r e n o t m a n y e m p i r i c a l s t u d i e s m e n t i o n s a b o u t d e t e r m i n a

n t s o f householdhealthcareexpenditureindevelopingcountriesaswellasinVietnam.Wecanlistheresomemainempiricalstudies:

Firstly,Himanshu ( 2 0 0 6 , 2007)studiedthedeterminants o f household

healthcareexpenditureinTribalandUrbanOrissa(India)withthreeworkingpapers

Twooftheseworkingpapersexploredtheinfluenceofhouseholdincomeandhouseholdhead’seducationonhouseholdhealthcareexpenditureinTribalandUrbanOrissa.Theregressiona n a l y s i s anddescriptive s t a t i s t i c s i s usedt o substantiateth e

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objective.Threevariablesareusedi nthemodel,i n c l u d i n g : household h e a l t h expenditure,householdi nc ome andeducationofthehouseholdhead;andthemodelthattheauthorusedinbothstudiesisalinearregressionmodel:PHE

§EDN

While:

Themodeluseperheadhealthexpenditure(PHE)torepresentthehouseholdhealthexpenditure,itiscalculatedbydividingtotalannualhealthexpenditureofthehouseholdbythehousehold size

Similarly,p e r h e a d incomeo f t h e h o u s e h o l d (PHI)i s u s e d forh o u s e h

incomehasthemostinfluenceonhealthcareexpenditure andithastheleastinfluenceinTribalarea.Thereasonisbecauseof

thelowerperheadincomeofthehouseholdi n Tribalandruralareathaninurbanarea

However,theinfluenceofeducationonhealthcareexpendituregives aninterestingfinding:“healthcareexpenditureinTribalareaisdoublethatofruralandurbanareas.Itmeansthataneducatedpersononanaveragespendssixpaisemoreinarupeethantheuneducatedp e r s o n o n healthexpenditureintribalareawhereasaneducatedpersoninbothruralandurbanareas,onanaveragespendsonlythreepaisemorei n arupeet h a n the un

ed uca te d p e r s o n ” T h e relativev a l u e s o f educationf o r Trialpeoplearemorethanthepeople ofruralandurbanareascausethisresults

Intheremainingworkingpaper,Himanshu(2006)mentionsabouttheimpact

UrbanOrissa.Byusingthesamemethodologyinthetwostudiesabove,thelinearregressionmodelwassuggestedas:PHE=§+ §P M H E +§P F H E

While:

PHEisperCapitaHealthExpenditure,itiscalculatedby“dividingtotalannualhealthexpenditureofthehousehold bythehouseholdsize”

PMHEispermalehealthexpenditure,itiscalculatedby“dividingtotalannualmaleh e

a l t hc a r e e x p e n d i t u r e o f theh o u s e h o l d b y n u m b e r o f malem e m b e r s o f thehousehold”

PFHEi s p e r f e m a l e h e a l t h e x p e n d i t u r e , it i s c a l c u l a t e d b y “ d i v i

d i n g t o t a lannualfemalehealthcareexpenditureofthehouseholdbynumberoffemalemembersofthehousehold”

Afterr u n n i n g regression,thea u t h o r h a s concludedt h a t “ b i o l o g i c a

l l y of-

determinedsexandsociallyconstructedgenderhavestrongbearingonthehouseholdout-pocketh e a l t h e x p e n d i t u r e T h e studys h o w s t h a t there i s asignificant differe ncebetweenmaleandfemaleo u t - o f -

p o c k e t

healthexpenditureinurbanarea”.However,out-of-pockethealthexpenditureoffemaleslivinginurbanishigherthan

pockethealthexpenditureishigherthanthefemale

ThenextisthestudyofP r a v i n K.Trivedi(2002)thatmentionedab o u t the

householdhealthcareexpendituresinVietnam.Healthcareexpenditureisonlyapartofthisstudy.TheauthorusedVHLSS1 9 9 7 -

1 9 9 8 toanalyzehealthcareexpenditureinbothindividualandhouseholdlevel

sizeforstudyinginindividuallevelis8081.Aregressionanalysisofmedicalexpenditureisusedinthestudywiththefollowingvariables:

Thedependentvariableis logofhealthcareexpendituref o r eachmemberoftheh o u s e h o l d w i t h t h e c o n d i t i o n t h e h e a l t h c a r e e x p e n d i t u r e f o r thati n d

i v i d u a l i s positive.T h e h e a l t h c a r e e x p e n d i t u r e h e r e i n c l u d e d a l l t y p e s o fhealthc a r e expenditureinthe4weekperiodprecedingthesurvey

Theindependentva r i a b l e s a r e usedi n thestu dy includes:householdi n

c o m e andhealthinsuranceare themainindependentvariablesbecauseth is analysisfocusontheimpactofhouseholdincomeandhealthinsuranceonhealthcareexpenditure

Theauthora l s o c o n t r o l l e d s o m e othervariablesi n themo de l s u c h as thea g e, the

Toanalyzethehealthcareexpenditureinthehouseholdl e v e l , thesamplesizeuse

df o r analysis i s 5 0 0 6 T he s t u d y a n a l y z e t h e a g g r e g a t e h e a l t h c a r e c o s t s o fallhouseholdsmemberisausefulcheckontheresultsoftheindividualdataanalysis.Bythisway,italsohelptoestimatetheEnglecurveforhealthc a r e expenditures.T h i s approachi s limitedbecauset h e healths t a t u s ofthehouseholdm e m b e r s a r e unablecontrolled.Themodelregressionalsocontrolledsomeofotherrelevantvariablessuchashouseholdsize,gender,age,householdheads’educationlevelsandlocation

(urbanorrural).Thelinearregressionmodelwasalsousedforthehouseholdlevelanalysisandtheresultshowsthat:

Agea n d s e x o f t h e h o u s e h o l d headh a v e s i g n i f i c a n t impacto n h o u

s e h o l d healthcaree x p e n d i t u r e O n a v e r a g e , t h e ho use ho lds w i t h a f e m a l e

h o u s e h o l d h e a d paidmoreforhealthcarethanoneswithamalehouseholdheadandhouseholdswitholderheadsalsospendmoreforhealthcare.However,

Wec o n t i n u e w i t h t h e s t u d y o f C a t h a r i n a H j o r t s b e r g (2 0 0 0 ) , t h i s p a p e r analyzesthedeterminantsoftotalhealthcareexpenditureofahouseholdandexpla

economicgroupsin

Class13

Accessv a r i a b l e s

-D i s t a n c e ( -D i s t a n c e t o thene arest h e a l t h c a r e f a c i l i t y i n km);Vehicle( I f

t h e h o u s e h o l d o w n i t s o w n v e h i c l e o r n o t ) ; L o c a t i o n (Indicatesi f t h e householdislocatedinaruralarea)

Inthispaper,theresearcheru s e d regressionm e t h o d s t o estimatehealthc

e s u g g e s t e d i n t h e m o d e l h a v e significantimpactonhouseholdhealthcareexpenditure

Thee s t i m a t e r e s u l t s i n d i c a t e s t h a t t h e h o u s e h o l d s ’ e c o n o m i c c i r

c u m s t a n c e s andaccess to health c a r e f a c i l i t i e s h a v e d i r e c t l y i m p a c t o n h

e a l t h e x p e n d i t u r e s b y Zambianhouseholds.Zambianhouseholds’healthcareexpenditureareinfluencedbytotalmonthlyexpenditureand monthlyexpenditures o

n otherthanfood.Householdsizean d t h e w e a l t h o f theh o u s e h o l d c a n d i r e c t l y r e l a t e t o b o t h o f thesev a

r i a b l e However,whenc o n s i de r i n g thedifferenceamongthreepovertyg r o u p s, it becomesmoreclearthatpoorhouseholdsormoderatelypoorhouseholdsaremoresens

tothelevelofexpenditureonotherthanfoodthannon-poorhouseholds.Ownershipofhouseisadummyvariableandisalsoaproxyo f economiccircumstances.Andtheresulti n d i c a t e s thath ous e h ol ds w h o a c tua lly

o w n theiro w n h o u s e s p e n d moreo n healthcarethanhouseholdsnotowningtheirownhouse

13

o ut a vehicle.M o r e o v e r , t h e h o u s e h o l d

’

healthcareexpenditurelevelisalsoaffectedbythedistancetothenearesthealthcarefacility.However,theresultshowt h a t distancedoesnotaffectonhealthcareexpenditureofnon-

poorhouseholds.Withtherespecttothehouseholdl o c a t i o n , theregressionresultpresentthatthelevelofruralhouseholdhealthcareexpendituresislowerthanurbanhouseholds I t takeslongertoreachahealthfacility i n rurala reas thanitdoesinu r b a

n areasw i t h giventhesamedistance.Thelessdevelopedinfrastructureinruralareasmaybethereasonofthis

Lastly,householdhealthcaree x p e n d i t u r e levelisa l s o i n f l u e n c e d bythedemographiccharacteristicsofthehousehold.Householdsizeisasignificantvariablethat

i m p a c t ont o t a l h e a l t h caree x p e n d i t u r e s , householdhavelargern u m b e

r ofmemberstendtospendmoreonhealthcare.Otherwise,householdhead’sageisalsoanimportantdeterminantofhouseholdhealthcareexpenditure

Final,MaathaiK.Mathiyazhagan,(2003)alsoanalyzed therelationship

betweenRuralHouseholdCharacteristicsandHealthexpenditureinIndia

Int h i s p a p e r , t h e a u t h o r a l s o u s e d literatureofh e a l t h careu t i l i z a

t i o n forstudyinghouseholdhealthcareexpenditure.Baseonthehouseholdeconomicstheory,itisassumedthat“householdsgetutilityor satisfactionfr om consuminggoodsandservices”,andtodesireforconsumption“householdmembersmustproducemanyofthecommodities”.Andthepaperalsoassumesthat“the utilizationofhealthservices