Who is bearing the financial burden of non-communicable diseases in Mongolia?
Who is bearing the financial burden of non-communicable diseases in Mongolia?
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DOI：
10.7189/jogh.08.010415
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发表时间：
2018-06-01
影响因子：
7.2
通讯作者：
Mahal, Ajay
中科院分区：
文献类型：
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作者：
Dugee, Otgontuya;Palam, Enkhtuya;Mahal, Ajay
背景非传染性疾病（NCD）对低收入和中等收入国家（LMICs）的健康和发展构成巨大挑战。然而，由于缺乏关于非传染性疾病筹资及其分配影响的具体国家证据，将这一挑战转化为资源分配受到严重制约。本研究估计与非传染性疾病在蒙古及其分布在社会经济群体，特别是对私人自付（OOP）支出的主要NCDs.Methods二级数据分析的多个数据来源的非传染性疾病相关的卫生服务的使用和支出，包括详细的行政数据，世界卫生组织逐步监测方法（STEPs）调查蒙古，和家庭调查。非传染性疾病OOP支出的样本加权估计是使用STEPs数据构建的。每次出院和每次门诊就诊的OOP支付估计的条件和类型的服务提供者，和调查数据的利用率，调整后的行政records.Results利用在蒙古的非传染性疾病占三分之一以上的卫生总支出在2013年。这一支出的很大一部分是由家庭以OOP支出的形式承担的。CVD相关的卫生支出是蒙古非传染性疾病支出的主要驱动力，约占卫生支出总额的24.2%。OOP的健康支付，主要是由门诊诊断和药物驱动，产生的富裕，寻求更多的专科服务和更好的质量的私人care.Conclusion的OOP支出的高份额的非传染性疾病在蒙古，表面上享有全民健康保险，提供了一个警示故事，在类似的情况下，中低收入国家。改善初级保健和农村保健设施的服务质量是可取的，因为穷人主要到这些设施看病，同时还应实行有效的免除上级医院使用费的政策。
Background Non-communicable diseases (NCDs) pose a formidable health and development challenge for low-and middle-income countries (LMICs). However, translating this challenge into resource allocation is seriously constrained by a lack of country specific evidence on NCD financing and its distributional implications. This study estimated expenditures associated with NCDs in Mongolia and their distributions across socioeconomic groups, focusing especially on private out-of- pocket (OOP) spending on the major NCDs.Methods Secondary data analysis of multiple data sources on NCD related health service use and expenditures including detailed administrative data, World Health Organization STEPwise approach to Surveillance (STEPs) survey for Mongolia, and household surveys. Sample-weighted estimates of OOP expenditures for NCDs were constructed using STEPs data. OOP payments per discharge and per outpatient visit were estimated by condition and type of service provider, and survey data on utilization, after adjusting for utilization in administrative records.Results NCDs in Mongolia accounted for more than one-third of total health expenditures in 2013. A significant fraction of this expenditure was borne by households in the form of OOP spending. CVD-related health spending is the major driver of NCD-spending in Mongolia, accounting for about 24.2% of total health expenditure. OOP health payments, largely driven by outpatient diagnostics and drugs, were incurred disproportionately by the better-off, seeking more specialist services and better quality private care.Conclusion A high share of OOP spending for NCDs in Mongolia, which ostensibly enjoys universal health coverage, provides a cautionary tale for LMICs in a similar situation. Improvement in the quality of services at the primary care level and rural health care facilities, where the poor mainly attend, is desirable together with an effective exemption policy for user fees at higher level hospitals.