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

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.