What Predicts the Efficiency of Out-of-pocket Health Expenditures: Two Stages Analysis from Global Perspective Efficiency of OOPHEs

The aim of this study is to examine the efficiency of out-of-pocket health expenditures (OOPHE) of countries and the factors affecting efficiency. In the scope of the study, no sampling was conducted, and an attempt was made to access data from all countries. The data was obtained from the World Bank database. The data for 162 countries with complete information was categorized into four different income groups: low-income, lower-middle-income, upper-middle-income, and high-income. Data from the years 2010 to 2019 were included in the analysis, and a two-stage analysis was conducted, including Data Envelopment Analysis (DEA) and panel Tobit regression. According to the results of the analyses, Universal Insurance Coverage (UHC) and LE life expectancy (LE) positively affected the technical efficiency of OOPHE, while female population ratio, chronic diseases, maternal mortality ratio (MMR), and infant mortality ratio (IMR) negatively affected it (p<0.05). Healthcare policymakers should ensure the fair and equitable distribution of the financial burden, especially considering the non-deferrable nature of healthcare services and the potential for more severe consequences if needs are not met, in order to prevent the impoverishing effect of OOPHE on individuals.