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The out of pocket payments in low and middle-income countries and the affecting factors: a systematic review and meta-analysis

  • Esmat Nemati ,
  • Shirin Nosratnejad ,
  • Leila Doshmangir ,
  • Vahideh Zarea Gavgani ,


Introduction: The out of pocket (OOP) payment is the most important source of health system financial support in low and middle-income countries (LMICs); therefore, considering and controlling health expenses are pivotal issues. The present study aimed to determine the households OOP payments in LMICs.

Method: Electronic databases, including Web of Science, Scopus, and PubMed were searched systematically in September 2015. Relevant papers on OOP payment in LMICs were included in the study. OOP payment was estimated as a percentage of Gross Domestic Product (GDP) per capita and household final consumption expenditure per capita in every country.

Results: Seventeen papers out of 3714 were included in the study. Eight studies were conducted in low-income countries, eight in middle-income countries, and one in both low and middle-income countries. The mean OOP payment as a percentage of households final consumption expenditure in LMICs was 0.67(α= 0.000, CI: 0.35-1.003) and the mean of OOP payment as a percentage of GDP in these countries was 1.65(α=0.000, CI: 1.57-1.72).

Conclusion: The households in LMICs face high levels of OOP payment. Therefore, many challenges must be overcome in financial support of health sectors. Health system policies and strategies are necessary to reform interventions in financing resources and purchasing health care services.


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How to Cite

Nemati, E., Nosratnejad, S., Doshmangir, L., & Zarea Gavgani, V. (2019). The out of pocket payments in low and middle-income countries and the affecting factors: a systematic review and meta-analysis. Bali Medical Journal, 8(3), 733–740.




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Esmat Nemati
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Shirin Nosratnejad
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Leila Doshmangir
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Vahideh Zarea Gavgani
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