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<JournalTitle>Journal of Medical and Surgical Research</JournalTitle>
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<Volume-Issue>Vol. XII, n 2</Volume-Issue>
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<IssueTopic>Multidisciplinary</IssueTopic>
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<Season>December 2025</Season>
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<Year>2025</Year>
<Month>12</Month>
<Day>31</Day>
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<ArticleType>JMSR Public Health</ArticleType>
<ArticleTitle>Household financial protection against health risks: A systematic review of the determinants of out-of-pocket health expenditures</ArticleTitle>
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<ArticleLanguage>English</ArticleLanguage>
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<FirstPage>1476</FirstPage>
<LastPage>1485</LastPage>
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<Author>
<FirstName>Aazelarab</FirstName>
<LastName>Boughaleb</LastName>
<AuthorLanguage>English</AuthorLanguage>
<Affiliation/>
<CorrespondingAuthor>N</CorrespondingAuthor>
<ORCID/>
<FirstName>Mounir</FirstName>
<LastName>Jerry</LastName>
<AuthorLanguage>English</AuthorLanguage>
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<CorrespondingAuthor>Y</CorrespondingAuthor>
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<Abstract>Introduction: Out-of-pocket (OOP) health expenditures are a major barrier to Universal Health Coverage (UHC), exposing households to financial catastrophe (SDG indicator 3.8.2) and impoverishment. While many determinants are known, a consolidated framework to guide policy action is lacking. This systematic review aims to synthesize the evidence on OOP determinants to develop and apply a novel hierarchical framework for policy analysis.
Methods: Following the PRISMA 2020 guidelines, a systematic search of academic databases and grey literature published between January 2000 and May 2025 was conducted. The selection process included an AI-assisted thematic screening followed by manual validation. Ultimately, 72 documents were included in the narrative synthesis and quality assessment using JBI tools.
Results: The findings reveal a four-level __doublequotosingCascade of Vulnerability.__doublequotosing At the systemic level, governance and financing choices notably low public health expenditure as a share of Total Health Expenditure (THE) and the absence of risk-pooling create a high-risk environment. This risk is activated by health shocks such as chronic illnesses and hospitalizations, acting as triggers. The financial impact is ultimately amplified by household-level vulnerabilities, including low socioeconomic status, rural residence, and the presence of elderly members.
Conclusion: Our synthesis suggests that the level of OOP spending is a measurable reflection of a health system__ampersandsign#39;s policy choices rather than an inevitability. Its reduction requires a multidimensional strategy (budgetary, operational, behavioral, and technological). The proposed hierarchical framework provides a foundation for future research based on predictive econometric modeling and scenario simulation to guide reforms toward measurable financial protection targets.</Abstract>
<AbstractLanguage>English</AbstractLanguage>
<Keywords>Catastrophic Health Expenditure, Determinants, Financial Protection, Health Financing, Out-of-Pocket Health Expenditure, Systematic Review, Universal Health Coverage (UHC)</Keywords>
<URLs>
<Abstract>https://www.journal-jmsr.net/ubijournal-v1copy/journals/abstract.php?article_id=16146&title=Household financial protection against health risks: A systematic review of the determinants of out-of-pocket health expenditures</Abstract>
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<ReferenceslastPage>19</ReferenceslastPage>
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