Effect of household and village characteristics on financial catastrophe and impoverishment due to health care spending in Western and Central Rural China: A multilevel analysis.
Effect of household and village characteristics on financial catastrophe and impoverishment due to health care spending in Western and Central Rural China: A multilevel analysis.
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DOI：
10.1186/1478-4505-9-16
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发表时间：
2011-04-06
影响因子：
4
通讯作者：
Brombal D
中科院分区：
文献类型：
--
作者：
Shi W;Chongsuvivatwong V;Geater A;Zhang J;Zhang H;Brombal D
本研究旨在探讨家庭和社区特征对中西部农村中国因医疗费用引起的金融灾难和贫困的影响。2008年，采用多阶段抽样技术在河北、陕西和内蒙古自治区进行了一次家庭调查。自变量包括村庄特征、家庭收入、慢性病状况、卫生保健使用情况和卫生支出。通过因子分析，从每个村庄的社会经济地位和卫生保健设施的可获得性得出了一个复合的背景变量，称为村庄剥夺。因变量为家庭卫生支出是否超过家庭支付能力的40%(灾难性卫生支出)，以及在卫生支出(贫困)后家庭人均收入是否被置于国家贫困线以下(1067元/年)。采用混合效应Logistic回归分析自变量对两种结果的影响。人均收入低、有年老、住院或患有慢性病的成员以及户主失业的家庭更有可能因卫生支出而招致金融灾难和贫困。随着村庄贫困的增加，灾难性的和贫困的医疗费用都增加了。然而，村卫生室的存在对这两个结果没有影响，家庭参加新型农村合作医疗计划(国家医疗保险)也没有影响。在对已知的家庭层面因素进行调整后，村庄贫困独立增加了因健康支付而出现经济困难的风险。这表明，政策制定者需要将个人、家庭和村庄视为政策目标的单独单位。
The study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central Rural China. A household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Independent variables included village characteristics, household income, chronic illness status, health care use and health spending. A composite contextual variable, named village deprivation, was derived from socio-economic status and availability of health care facilities in each village using factor analysis. Dependent variables were whether household health payment was more than 40% of household's capacity to pay (catastrophic health payment) and whether household per capita income was put under Chinese national poverty line (1067 Yuan income per year) after health spending (impoverishment). Mixed effects logistic regression was used to assess the effect of the independent variables on the two outcomes. Households with low per capita income, having elderly, hospitalized or chronically ill members, and whose head was unemployed were more likely to incur financial catastrophe and impoverishment due to health expenditure. Both catastrophic and impoverishing health payments increased with increased village deprivation. However, the presence of a village health clinic had no effect on the two outcomes, nor did household enrollment in the New Rural Cooperative Medical Scheme (national health insurance). Village deprivation independently increases the risk for financial hardship due to health payment after adjusting for known household-level factors. This suggests that policy makers need to view the individual, household and village as separate units for policy targeting.
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