COPING WITH HEALTH-CARE COSTS: IMPLICATIONS FOR THE MEASUREMENT OF CATASTROPHIC EXPENDITURES AND POVERTY
COPING WITH HEALTH-CARE COSTS: IMPLICATIONS FOR THE MEASUREMENT OF CATASTROPHIC EXPENDITURES AND POVERTY
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DOI：
10.1002/hec.1338
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发表时间：
2008-12-01
期刊：
影响因子：
2.1
通讯作者：
Van Doorslaer, Eddy
中科院分区：
文献类型：
--
作者：
Flores, Gabriela;Krishnakumar, Jaya;Van Doorslaer, Eddy
在没有正式医疗保险的情况下，我们认为，家庭采取的资助医疗保健的策略对于衡量和解释医疗支出如何影响消费和贫困具有重要影响。考虑到资金来源的数据，我们建议：(A)用“应对”调整后的医疗支出比率来近似医疗支出对当前消费的相对影响，(B)揭示由于家庭总支出被财务应对策略夸大而被“隐藏”的贫困，以及(C)确定“暂时”的贫困，因为必要的消费是暂时牺牲的，以支付医疗费用。忽视应对策略的措施不仅夸大了当前消费的风险，夸大了灾难性支出的规模，还忽视了医疗支出的长期负担。来自印度的具有全国代表性的数据显示，应对策略为住院护理费用提供了高达四分之三的资金。大约30%的住院家庭的住院费用超过了家庭总支出的10%，但只有不到4%的人牺牲了超过10%的当前消费来满足这一支出。忽视医疗费用会导致住院家庭低估贫困7-8%；这种调整中有80%是由于应对而导致的隐性贫困。版权所有(C)2008 John Wiley&Sons，Ltd.
In the absence of formal health insurance, we argue that the strategies households adopt to finance health care have important implications for the measurement and interpretation of how health payments impact on consumption and poverty. Given data oil source of finance, we propose to (a) approximate the relative impact of health payments on current consumption with a 'coping'-adjusted health expenditure ratio, (b) uncover poverty that is 'hidden' because total household expenditure is inflated by financial coping strategies and (c) identify poverty that is 'transient' because necessary consumption is temporarily sacrificed to pay for health care. Measures that ignore coping strategies not only overstate the risk to current consumption and exaggerate the scale of catastrophic payments but also overlook the long-run burden of health payments. Nationally representative data from India reveal that coping strategies finance as much as three-quarters of the cost of inpatient care. Payments for inpatient care exceed 10% of total household expenditure for around 30% of hospitalized households but less than 4% Sacrifice more than 10% of current consumption to accommodate this spending.Ignoring health payments leads to underestimate poverty by 7-8% points among hospitalized households; 80% of this adjustment is hidden poverty due to coping. Copyright (C) 2008 John Wiley & Sons, Ltd.