Evaluating inequalities in out-of-pocket expenditures across inpatient and outpatient services in Honduras

Out-of-pocket (OOP) healthcare expenditures are a major barrier to achieving universal health coverage in low- and middle-income countries (LMICs). In Honduras, OOP payments constitute a significant burden, particularly for vulnerable populations. However, evidence on the socioeconomic distribution of these expenditures and their determinants remains scarce. This study aims to examine the socioeconomic inequalities in OOP healthcare expenditures in Honduras, focusing on outpatient and inpatient services. It seeks to identify key sociodemographic factors contributing to these disparities to inform equitable health care financing policies. Data from the 2019 ENDESA/MICS survey was used, covering 10,998 individuals for outpatient and 3,277 for inpatient services. Concentration curves (CC) and the Wagstaff concentration index (CI) were used to measure inequality in OOP expenditures. An econometric decomposition analysis of the CI was performed to identify the contribution of sociodemographic factors. The findings indicate that OOP expenditures for both outpatient (CI = 0.213) and inpatient services (CI = 0.218) are disproportionately concentrated among wealthier individuals. Education and place of residence were primary drivers of inequality, with rural residents and those without insurance experiencing greater financial burdens. The study highlights significant socioeconomic inequalities in OOP healthcare expenditures in Honduras. Policy interventions targeting financial protection for lower-income and rural populations are crucial to advancing equitable healthcare access.