Coping with out-of-pocket health payments: empirical evidence from 15 African countries
Coping with out-of-pocket health payments: empirical evidence from 15 African countries
复制标题
DOI：
10.2471/blt.07.049403
复制
发表时间：
2008-11-01
期刊：
影响因子：
--
通讯作者：
Xu, Ke
中科院分区：
文献类型：
--
作者：
Leive, Adam;Xu, Ke
目的 探讨 15 个非洲国家家庭面对医疗支出的应对行为的相关因素，为政策制定者设计财务健康保障机制提供证据。 方法 采用一系列 Logit 回归来探讨与出售资产、借贷或两者兼而有之的可能性更大的相关因素。通过计算每次观察的部分效应并取样本的平均值，得出不同住院护理支出水平的平均部分效应。分析中使用的数据来自 2002-2003 年世界健康调查，该调查询问了家庭在上一年如何自付费用。将出售资产或借钱的家庭与通过收入或储蓄资助医疗保健的家庭进行比较。那些使用保险的人被排除在外。在分析中，出售资产或借钱的值为 1，其他应对机制的值为 0。调查结果 通过借贷和出售资产来应对的家庭比例从赞比亚的 23% 到布基纳法索的 68%。一般来说，最高收入群体借入和出售资产的可能性较小，但较低收入五分之一群体的应对机制并没有太大差异。与那些为门诊护理或日常医疗费用提供资金的家庭相比，住院费用较高的家庭更有可能借贷和耗尽资产，但布基纳法索、纳米比亚和斯威士兰除外。在八个国家中，住院支出最高五分之一的系数的 P 值低于 0.01。 结论 在大多数非洲国家，卫生筹资体系太薄弱，无法保护家庭免受健康冲击。借入和出售资产来资助医疗保健的情况很常见。正式的预付款计划可以使许多家庭受益，而全面的社会保护网络可以帮助减轻健康状况不佳对家庭福祉的长期影响并支持减贫。
Objective To explore factors associated with household coping behaviours in the face of health expenditures in 15 African countries and provide evidence for policy-makers in designing financial health protection mechanisms.Methods A series of logit regressions were performed to explore factors correlating with a greater likelihood of selling assets, borrowing or both to finance health care. The average partial effects for different levels of spending on inpatient care were derived by computing the partial effects for each observation and taking the average across the sample. Data used in the analysis were from the 2002-2003 World Health Survey, which asked how households had financed out-of-pocket payments over the previous year. Households selling assets or borrowing money were compared to those that financed health care from income or savings. Those that used insurance were excluded. For the analysis, a value of 1 was assigned to selling assets or borrowing money and a value of 0 to other coping mechanisms.Findings Coping through borrowing and selling assets ranged from 23% of households in Zambia to 68% in Burkina Faso. In general, the highest income groups were less likely to borrow and sell assets, but coping mechanisms did not differ strongly among lower income quintiles. Households with higher inpatient expenses were significantly more likely to borrow and deplete assets compared to those financing outpatient care or routine medical expenses, except in Burkina Faso, Namibia and Swaziland. In eight countries, the coefficient on the highest quintile of inpatient spending had a P-value below 0.01.Conclusion In most African countries, the health financing system is too weak to protect households from health shocks. Borrowing and selling assets to finance health care are common. Formal prepayment schemes could benefit many households, and an overall social protection network could help to mitigate the long-term effects of ill health on household well-being and support poverty reduction.