Beyond catastrophic payments: modeling household health expenditure shares with endogenous selection

Antonello Maruotti (), Pierfrancesco Alaimo Di Loro () and Cathleen Johnson ()
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Antonello Maruotti: LUMSA University
Pierfrancesco Alaimo Di Loro: LUMSA University
Cathleen Johnson: West Virginia University

AStA Advances in Statistical Analysis, 2025, vol. 109, issue 2, No 6, 363-386

Abstract: Abstract The primary purpose of this paper is to assess households’ burden due to out-of-pocket healthcare expenditures. These payments are modeled on a representative sample of 25668 Italian households as the fraction of out-of-pocket healthcare expenditures over the households’ capacity to pay. For this purpose, we propose extending the analysis of the so-called catastrophic payments by looking at the entire distribution of this ratio. We introduce a novel finite mixture regression able to capture different levels of heterogeneity in the data. By using such a model specification, the fairness of the Italian National Health Service and its determinants are investigated.

Keywords: Health expenditures; Out-of-pocket health expenditures; Finite mixtures; Zero-adjusted distributions; Endogenous selection (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1007/s10182-024-00519-w

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