OBJECTIVES: The analysis of health inequality is essential for providing the evidence on who is being left behind and informs equity-oriented policies, programs, and practices. Therefore, socioeconomic inequalities in Out-of-Pocket Health Expenditures (OOPHEs), Catastrophic Health Expenditures (CHEs) and contribution of different factors in inequalities are assessed in this study.

METHODS: Three rounds of the Household Integrated Economic Survey (HIES,2007-08, 2011-12, and 2018-19) conducted by the Pakistan Bureau of Statistics (PBS) are used. These socioeconomic inequalities are measured through concentration curves, concentration, slop, and relative Index of Inequality (CI, SII, and RII). Decomposition analyses are conducted using methods developed by Wagstaff (2005) and Erreygers (2009).

RESULTS: The distribution of OOPHEs and CHEs are found to be pro-rich and pro-poor, respectively. It was found that socioeconomic inequalities in OOPHEs and CHEs are increased over time (between 2007-08 and 2018-19). The findings of CI show that OOPHEs are more concentrated among the high socioeconomic group while the reverse is true for CHEs. The SII of OOPHEs increased by 0.88% and 1.32% from lower to higher income group across time. On the other hand, CHEs have decrease from 7% to 5 % over the same period. The findings of RII showed that probability of bearing the OOPHEs is higher for the richest group, while RII of CHEs shows the poorest group have to bear higher CHEs.

CONCLUSIONS: The socioeconomics inequalities in OOPHEs and CHEs are estimated to be higher among the poorest group compared to the richest group. Poor households with CHEs, are at a higher risk of impoverishment, should be the focus of social protection initiative such as unconditional cash transfer programs.