The impact of out-of-pocket health expenditure on household impoverishment: Evidence from Morocco

Int J Health Plann Manage. 2019 Oct;34(4):e1569-e1585. doi: 10.1002/hpm.2848. Epub 2019 Jul 22.


Health financing in Morocco relies mainly on out-of-pocket (OoP) payments. World Health Organization (WHO) has shown that these payments can expose households to catastrophic health expenditure (hereinafter CHE) and impoverish them. The study examines the financial burden of OoP health payments on Moroccan households. Two approaches-that developed by Wagstaff and Doeslear and the one advocated by WHO-are adopted to estimate the extent of CHE. These show that 1.77% of households incurred CHE at the 40% threshold for nonfood expenditure. At the 10% threshold for total consumption expenditure, 12.8% of households incurred CHE. We find that these OoP payments have made 1.11% of Moroccan households poorer. In analyzing the determinants of CHE, we estimated an ordered probit model. It appears that any of (a) hospitalization, (b) presence of an elderly person in the household, or (c) the level of poverty increases significantly the likelihood of health expenditure becoming catastrophic. On the other hand, we find that coverage by health insurance protects against CHE.

Keywords: CHE; catastrophic payments; health system financing; out-of-pocket payments; poverty.

MeSH terms

  • Cost of Illness
  • Delivery of Health Care / economics
  • Delivery of Health Care / organization & administration
  • Family Characteristics*
  • Female
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Models, Econometric
  • Morocco
  • Poverty / economics*
  • Poverty / statistics & numerical data