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Mohammed Elhaj Mustafa Ali, Eltayeb Mohamedain Abdalla (2021). Out of Pocket Healthcare Expenditures: Determinants and Impacts on the Livelihoods of Urban Households in Selected Sudanese States. Bergen: Chr. Michelsen Institute (Sudan Working Paper SWP 2021:1)

This study investigates determinants of out-of-pocket and catastrophic healthcare expenditures (OOPHE and CHE) incurred by urban households in five Sudanese states, namely, Red Sea, Kassala, Gadarif, Sinnar, and South Darfur. The study also examines the impact of CHE on the livelihoods of households in these states. To achieve these aims, the study applies ordinary least squares (OLS) and probit regression methods to data sourced from Sudanese National Baseline Household Surveys (NBHSs) conducted in 2009 and 2014. 

An analysis based on the 2009 NBHS shows that OOPHE is significantly influenced by factors such as household size, the head of household’s educational level, and the presence of elderly household members. When the 2009 data is disaggregated to the state level, however, the analysis demonstrates that household income, enrollment in a health insurance program, very young (under age 5) household members, the head of household’s educational level, the head of household’s gender, and the family’s wealth correspond the most significantly to the amount of OOPHE a family incurs. Interestingly, the analysis based on the 2014 NBHS indicates that health insurance, the family’s wealth, and the head of household’s age, gender, wage employment, and marital status are correlated with OOPHE. The analysis based on disaggregated data from 2014 indicates that OOPHE is significantly correlated with factors such as  the head of household’s age, household size, the head of household’s educational level, wealth, and distance from healthcare facilities. Furthermore, the analysis shows that CHE is significantly correlated with health insurance enrollment, family wealth, household size, distance from healthcare facilities, and the head of household’s age and education. Finally, the investigation reveals that a high level of CHE is accompanied with lower shares of food and non-food purchases in a household’s total expenditures and, thus, worsens households’ livelihoods in those other domains. Based on these findings, the study ends with some recommendations aimed at alleviating the burden of private healthcare spending on urban households in the states under consideration.