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The International Journal of Health Planning and Management
Article . 2023 . Peer-reviewed
License: CC BY NC ND
Data sources: Crossref
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Informal employment and catastrophic health expenditures: Evidence from Pakistan

Authors: Shabana Kishwar; Saima Bashir; Akseer Hussain; Khorshed Alam;

Informal employment and catastrophic health expenditures: Evidence from Pakistan

Abstract

AbstractWorkers in informal employment suffered significant out‐of‐pocket healthcare expenditures (OOPHEs) due to their low earnings and a lack of a social safety net or health insurance. There is little or no evidence of impoverishment caused by OOPHEs in the context of labor market categorization. Therefore, this study examines the economic burden of OOPHEs and its associated consequences on households, whose members are in informal employment. This study estimates the incidence of catastrophic health expenditures (CHEs) and impoverishment across the households in formal and informal employment and their key determinants in Pakistan by employing the data from the two rounds of the Household Integrated Economic Survey (2015‐16, 2018‐19). For measuring CHEs and impoverishment, the budget share and capacity‐to‐pay approaches are applied. Various thresholds are used to demonstrate the sensitivity of catastrophic measures. We found a higher incidence of catastrophic healthcare payments among the informal workers, that is, 4.03% and 7.11% for 2015‐16 and 2018‐19, respectively, at a 10% threshold, while at a 40% threshold, the incidence of CHEs is found to be 0.40% and 2.34% for 2015‐16 and 2018‐19, respectively. These OOPHEs caused 1.53% and 3.66% of households who are in informal employment to become impoverished, compared with their formal counterparts. The study demonstrates that the probability of incurring CHEs and becoming impoverished is high among informal workers, compared with their formal counterparts. This result has clear policy implications, in which to protect the informal workers, it is necessary to expand the insurance coverage, particularly during the COVID‐19 response and recovery efforts.

Countries
Germany, United Kingdom, United Kingdom, Australia, United Kingdom
Keywords

Employment, 330, Taurine, catastrophic health expenditures, impoverishment, COVID-19, healthcare expenditures, Catastrophic health expenditures, informal employment, Humans, Pakistan, Health Expenditures, out of pocket health expenditures, Catastrophic Illness, Poverty

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    popularity
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    Top 10%
    influence
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
4
Top 10%
Average
Average
Green
hybrid