Ahmed Rashad


Out-of-pocket health payments can cause financial hardship to households, which may push them into poverty. The purpose of this thesis is to examine the impact of out-of-pocket health payments on households' economic situation in Egypt using a national representative survey. On the other hand, the conventional poverty estimates do not take the effect of out-of-pocket health payments on households into account. Therefore, by reassessing the poverty estimates taking into account out-of-pocket health payments, this thesis provides new poverty estimates that reflect the poverty impact of out-of-pocket health payments. The thesis adopts the World Health Organization's methodology in measuring the extent of catastrophic health expenditure and impoverishment. It uses a logit model to identify the determinants of catastrophic health expenditure. The quantitative analysis yields that out-of-pocket health payments exacerbate households' living especially the poor and the near poor. The thesis suggests that 6% of households encounter catastrophic health expenditure in 2010. It estimates that the poverty line for a household composed of four members, which is the average household size, equals LE 673.8 per month. It suggests that the 19.1% of households spend below the poverty line. However, additional 7.4% of households fall below the poverty line after paying for health care. In other words, the size of poverty in Egypt including those who are impoverished by health payment is 26.5%. Additionally, out-of pocket health payments have exacerbated the normalized poverty gap by 1.4%. The econometric analysis suggests that household with chronic sick member and poor households are the most vulnerable to catastrophic health expenditure.


Economics Department

Degree Name

MA in Economics

Graduation Date


Submission Date

January 2012

First Advisor

Shawky, Sherine

Second Advisor

Selim, Tarek



Document Type

Master's Thesis

Library of Congress Subject Heading 1

Medical care, Cost of -- Egypt.

Library of Congress Subject Heading 2

Health services accessibility -- Egypt.


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Institutional Review Board (IRB) Approval

Not necessary for this item


I am profoundly grateful to my supervisors Dr. Sherine Shawky, Researcher Professor at the Social Research Center, American University in Cairo and Dr. Samer Atallah, Assistant Professor of Economics, American University in Cairo for their valuable guidance and their unbroken encouragement and support throughout this research. It honors me to work under their supervision. I would also like to thank my reader, Dr. Tarek Selim, Associate Professor of Economics, American University in Cairo, not only for helping me throughout this research but also for his permanent support from my first day at the American University in Cairo. I owe my sincere gratitude to Dr. Laila El Baradei, Associate Dean for the School of Global Affairs and Public Policy. I am very grateful for her encouragement and support during my MA journey. My thanks to Ford Foundation for supporting my study at the American University in Cairo. I would also like to thank Dr. Jennifer Bremer, Chair of the Public Policy and Administration Department, for her precious advice. Filly yet importantly, I would like to thank Ms. Ola Gamil, Ms. Flora Ateya, Ms. Omnia Ahmed and Mr. Amr El Sayed for their permanent assistance.