Household catastrophic health expenditure: a multicountry analysis
Household catastrophic health expenditure: a multicountry analysis
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DOI：
10.1016/s0140-6736(03)13861-5
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发表时间：
2003-07-12
期刊：
影响因子：
168.9
通讯作者：
Murray, CJL
中科院分区：
文献类型：
--
作者：
Xu, K;Evans, DB;Murray, CJL
长期以来，卫生政策制定者一直关注保护人们免受健康状况不佳导致灾难性财政支付和随后的贫困的可能性。然而，灾难性支出并不罕见。我们调查了灾难性卫生支出的程度，作为制定适当政策应对措施的第一步。方法采用跨国分析设计。通过回归分析，利用59个国家的住户调查数据探索与灾难性卫生支出相关的变量。我们将支出定义为灾难性的，如果一个家庭对卫生系统的财务贡献超过满足生存需求后剩余收入的40%。各国面临自费医疗费用灾难性支付的家庭比例差异很大。在一些转型期国家和某些拉丁美洲国家，灾难性支出率最高。确定了灾难性支付的三个关键先决条件：提供需要支付的保健服务、支付能力低以及缺乏预付款或健康保险。通过减少卫生系统对自付费用的依赖和提供更多的财务风险保护，人们，特别是贫困家庭的人们，可以免受灾难性卫生支出的影响。增加提供保健服务对改善贫穷国家的健康至关重要，但这种做法可能会增加面临灾难性支出的家庭比例；在这种情况下，风险保护政策尤为重要。
Background Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. Yet catastrophic expenditure is not rare. We investigated the extent of catastrophic health expenditure as a first step to developing appropriate policy responses.Methods We used a cross-country analysis design. Data from household surveys in 59 countries were used to explore, by regression analysis, variables associated with catastrophic health expenditure. We defined expenditure as being catastrophic if a household's financial contributions to the health system exceed 40% of income remaining after subsistence needs have been met.Findings The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries. Catastrophic spending rates were highest in some countries in transition, and in certain Latin American countries. Three key preconditions for catastrophic payments were identified: the availability of health services requiring payment, low capacity to pay, and the lack of prepayment or health insurance.Interpretation People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection. Increase in the availability of health services is critical to improving health in poor countries, but this approach could raise the proportion of households facing catastrophic expenditure; risk protection policies would be especially important in this situation.