ABSTRACT:
Out-of-pocket (OOP) payments remain the predominant mode of financing health care in many developing countries, where weak public health systems and limited medical aid penetration persist. While the financial burden of OOP payments has long been recognised, less attention has been paid to their behavioural consequences. Patients facing OOP costs often exhibit loss aversion and related cognitive biases that discourage timely care-seeking, leading to delayed treatment or the choice of lower-cost but less effective alternatives. Health practitioners, as the key interface between patients and the health system, play a critical role in shaping decisions through the framing of cost-related information. This paper presents a diagnostic review of existing evidence and develops a protocol for behaviourally informed interventions aimed at reducing cognitive pitfalls associated with OOP health expenditures. We employ the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol to guide the review. By integrating insights from behavioural economics and health systems research, the study outlines practical strategies for reframing patient–practitioner interactions to promote equitable access to care, especially as health services are credence goods. The proposed protocol contributes to addressing health care disparities by improving patient decision-making in contexts where OOP payments remain a structural barrier. The results have implications for improving health services utilisation, adherence to medication as well as improving care.