Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences
Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences
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DOI：
10.1093/heapol/czn052
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发表时间：
2009-03-01
影响因子：
3.2
通讯作者：
Sharma, Bishnu P.
中科院分区：
文献类型：
--
作者：
Adhikari, Shiva R.;Maskay, Nephil M.;Sharma, Bishnu P.
在发展中国家，尽管公共卫生机构通常免费提供服务，但获得保健服务的家庭仍要支付大量费用。这对低收入家庭构成了经济负担，加剧了他们的贫困程度。除了获得医疗保健的经济负担外，支付这些费用的方法也影响到家庭资产的分配。对资源贫乏的家庭的影响更大，因为他们获得医疗保险的机会减少。然而，最近的文献忽视了为医疗保健支付提供资金的方法的重要性。本文着眼于尼泊尔的情况下，并强调对家庭的影响，支付医院为基础的护理黑热病（KA）通过分析灾难性的，灾难性的和经济后果的应对策略。该文件利用了随机选择的尼泊尔Siraha和Saptari地区50个受KA影响的家庭的微观数据。实证结果表明，直接费用的医院为基础的治疗KA是灾难性的，因为他们消耗17的家庭年收入。这项开支使20%以上受克山病影响的家庭生活在贫困线以下，其余家庭被推到边缘贫困类别;贫困差距比率超过90。此外，由于家庭求助于非正规部门的融资机制，KA发病率可能对家庭经济产生长期和严重的经济后果。沉重的贷款偿还负担可能导致家庭陷入恶性循环，最终成为贫困陷阱。换句话说，卫生保健支付的筹资方法是理解疾病经济负担的一个重要因素。
Households obtaining health care services in developing countries incur substantial costs, despite services generally being provided free of charge by public health institutions. This constitutes an economic burden on low-income households, and contributes to deepening their level of poverty. In addition to the economic burden of obtaining health care, the method of financing these payments has implications for the distribution of household assets. This effect on resource-poor households is amplified since they have decreased access to health insurance. Recent literature, however, ignores the importance of the method of financing health care payments. This paper looks at the case of Nepal and highlights the impact on households of paying for hospital-based care of Kala-azar (KA) by analysing the catastrophic, impoverishment and economic consequences of their coping strategies. The paper utilizes micro-data on a random selection of 50 of the KA-affected households of Siraha and Saptari districts of Nepal. The empirical results suggest that direct costs of hospital-based treatment of KA are catastrophic since they consume 17 of annual household income. This expenditure causes more than 20 of KA-affected households to fall below the poverty line, with the remaining households being pushed into the category of marginal poor; the poverty gap ratio is more than 90. Further, KA incidence can have prolonged and severe economic consequences for the household economy due to the mechanisms of informal sector financing to which households resort. A heavy burden of loan repayments can lead households on a downward spiral that eventually becomes a poverty trap. In other words, the method of financing health care payments is an important ingredient in understanding the economic burden of disease.