Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil
Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil
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DOI：
10.1093/ije/dyn063
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发表时间：
2008-08-01
影响因子：
7.7
通讯作者：
Bertoldi, Andrea D.
中科院分区：
文献类型：
--
作者：
Barros, Aluisio J. D.;Bertoldi, Andrea D.
背景 巴西免费且全民的公共卫生系统应限制自付费用。然而，据报道，巴西是遭受灾难性支出的家庭比例最高的国家之一。本研究旨在评估低收入人群中高额医疗支出的发生情况以及自付费用医疗支付的模式。 方法 2003 年在巴西阿雷格里港进行了一项横断面研究，样本代表的是家庭健康计划所覆盖的家庭。健康费用是根据访谈前 30 天记录的，收入数据是根据上一个日历月收集的。卫生支出是根据家庭总卫生支出>家庭收入的5%、10%和20%以及家庭支付能力>40%来探讨的。结果最终研究样本包括869个家庭。药品占家庭健康支出的 47%；其次是私人医疗计划，占 22%。平均而言，最富有的人在健康计划上的花费是最贫穷的人的 70 倍，在牙科治疗上的花费是最贫穷的人的 26 倍，在药品上的花费是最贫穷的人的 6 倍。大约 16% 的家庭将其收入的 20% 或更多用于健康，无论经济状况如何。同样，12% 的家庭的医疗支出超过其支付能力的 40%。 结论 不同经济群体的医疗支出收入比例相似，但这种平等的水平高得令人无法接受。需要采取具体策略来减少此类脆弱性。
Background The Brazilian public health system, free and universal, should limit out-of-pocket health expenses. However, Brazil was reported as one of the countries with the highest proportion of families experiencing catastrophic expenditure. This study was designed to assess occurrence of high health spending in a low-income population, as well as the pattern of out-of-pocket health payments.Methods A cross-sectional study was done in Porto Alegre, Brazil, in 2003, with a sample representative of families covered by the Family Health Program. Health expenses were recorded with reference to 30 days prior to the interview and income data were collected with reference to the previous calendar month. Health expenditure was explored in terms of total household health expenditure > 5, 10 and 20% of household income and > 40% households capacity to pay.Results The final study sample included 869 households. Medicines were responsible for 47% of household expenditure with health; second came private health plans which accounted for 22%. The richest spent, on average, 70 times more them the poorest with health plans, 26 times more with dental treatment and six times more with medicines. About 16% households committed 20% or more of their income with health, independent of economic position. Similarly, 12% of the households had health expenditure in excess of 40% of their capacity to pay.Conclusion The proportion of income spent on health was similar across economic groups, but this equality is achieved at an unacceptably high level. Specific strategies to reduce such vulnerability are needed.