Macroeconomic and financing determinants of out of pocket payments in health care: Evidence from selected OECD countries

Nikolaos Grigorakis, Christos Floros, Haritini Tsangari, Evangelos Tsoukatos

Research output: Contribution to journalArticle

4 Citations (Scopus)


In this paper, we examine the impact of macroeconomic, as well public and private health insurance financing (PHI) factors on out of pocket (OOP) healthcare expenditures, by using fixed/random effects and dynamic panel data methodology to a dataset of 26 EU and OECD countries for a period lasting from 1995 to 2013. The existing empirical literature has focused on testing the hypothesis that several macroeconomic and health financing determinants have an effect on OOP healthcare expenditures. Nevertheless, the related articles have not well tested the hypothesis concerning the potential impact of PHI financing on OOP spending. We find that public and PHI financing have a significant countervailing effect on OOP spending. Moreover, we show that unemployment rate has a significant positive impact on OOP expenditures. Sensitivity tests with variation of specifications and samples show that our findings are robust. We argue that policy-makers should give serious consideration to PHI institution; our results indicate that there is an inverse effect on OOP spending. We suggest that our examined countries have to provide financial risk protection to their citizens against OOP payments, rather than only attending health budgetary retrenchments in order to adjust public finances.

Original languageEnglish
Pages (from-to)1290-1312
Number of pages23
JournalJournal of Policy Modeling
Issue number6
Publication statusPublished - 1 Nov 2018


  • Macroeconomy
  • OOP healthcare expenditures
  • Panel data analysis
  • PHI
  • Public health financing

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