ArticleFrontiers in health services2026
Difference in out-of-pocket health expenditure among Syrian refugees in Jordan, Lebanon and the Kurdistan region of Iraq.
Article in Frontiers in health services, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Refugees frequently face financial barriers to healthcare, with out-of-pocket (OOP) payments representing a major obstacle to access. While studies often examine refugees' healthcare access within single-country settings, less comparative evidences exist on how host-country health system structures influence refugees' financial barriers to healthcare. Consequently, this study assesses differences in OOP healthcare expenditure among Syrian refugees residing in Jordan, Lebanon, and the Kurdistan Region of Iraq (KRI). Methods: We conducted a cross-sectional analysis using data from the "Syrian Refugee and Host Community Surveys, 2015-16". The analytic sample included a total of 2,679 Syrian refugee households from Jordan, Lebanon and KRI, that reported at least one healthcare visit in the previous 12 months. The outcome was any reported OOP payment at the point of care and the host country being the main exposure. Generalized Estimating Equations were used to estimate crude and adjusted odds ratios, accounting for clustering and sociodemographic covariates. Results: Cross-country variation in OOP expenditure was observed., where, refugee households reporting OOP payments were 39.5% in Jordan, 78.3% in Lebanon, and 73.3% in KRI. After adjustment, refugee households in Lebanon had over five times higher odds of incurring OOP payments compared with Jordan (AOR: 5.25, 95% CI: 1.57-17.5), while those in KRI had more than four times higher odds (AOR: 4.50, 95% CI: 1.34-15.1). Conclusions: Healthcare affordability among Syrian refugees differed markedly by host-country context, highlighting important cross-country differences in financial exposure to healthcare costs. These findings underscore the relevance of host-country setting in shaping refugees' experience of healthcare affordability and point to the need for greater financial protection to mitigate healthcare-related hardship in protracted displacement contexts.
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