A double-hurdle model of healthcare expenditures across income quintiles and family size : new insights from a household survey

The decision-making processes and outcomes of male and female household heads differ due to gender-based differences in preferences. In this paper, we assess the impact of this heterogeneity on household healthcare consumption in Thailand. Past studies modeling healthcare expenditures using household survey data used a gender dummy variable in regression models to control for household gender headship at the household level. Due to the endogeneity and self-selection bias in the past modelling approach, we separately modeled health expenditures for male and female household head decision makers. Using a household dataset from an earlier work, this study finds, using the double-hurdle model with dependent errors, that out-of-pocket health care spending tends to behave like a necessity across the income quintiles, household sizes, and differently for the separately modeled household gender heads. Moreover, male and female headed households responded differently to a major economic shock when adjusting household healthcare spending.