Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis
Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis
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DOI：
10.1371/journal.pone.0227565
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发表时间：
2020-01-14
期刊：
影响因子：
3.7
通讯作者：
Rahman, Md. Mizanur
中科院分区：
文献类型：
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作者：
Rahman, Md. Mahfuzur;Zhang, Cherri;Rahman, Md. Mizanur
背景由于孟加拉国非传染性疾病（NCD）的迅速增加和与医疗保健相关的财政问题的高负担，人们担心与疾病相关的自付（OOP）费用可能成为家庭的主要负担。关键是要了解什么是主要的疾病负责在家庭层面的高发病率，以帮助政策制定者优先考虑关键领域的行动，以保护家庭从100%的财政困难，寻求医疗保健作为全民健康保险的一部分。然后评估与这些疾病相关的家庭经济负担.MethodA横断面调查1593随机选择的家庭进行了在孟加拉国（拉杰沙希市城区），在2011年。灾难性支出估计为家庭支付能力的40%。我们采用贝叶斯两阶段的障碍模型和贝叶斯逻辑回归模型估计年龄调整后的平均成本和家庭财务灾难的发生率为每种疾病，resultsOverall，约45%的孟加拉国人口至少有一个发作的疾病。经年龄性别调整的家庭平均医疗费用和灾难性卫生保健支出分别为TK 621和8%。家庭在瘫痪方面的支出最高，为7 676.9英镑，其次是肝病（TK 2695.4）、伤害（TK 2440.0）、精神疾病（TK 2258.0）和肿瘤（TK 2231.2）。这些疾病也是金融灾难发生率较高的原因。我们的研究表明，24%的伤寒患者在肝病之后发生了灾难性的支出。（12.3%），肿瘤（12.1%），心脏病（8.4%），受伤（7.9%），精神疾病（7.9%），白内障（7.1%），瘫痪（6.5%）。ConclusionThe研究结果表明，慢性疾病负责高成本和高灾难性的支出在孟加拉国。有效的风险分担机制可以减轻家庭疾病相关的经济负担。与非传染性疾病有关的慢性病是OOP的主要原因。同样重要的是，应考虑优先照顾弱势群体，为某些慢性病的高额医疗保健费用提供补贴。
BackgroundBecause of the rapid increase of non-communicable diseases (NCDs) and high burden of healthcare-related financial issues in Bangladesh, there is a concern that out-of-pocket (OOP) payments related to illnesses may become a major burden on household. It is crucial to understand what are the major illnesses responsible for high OPP at the household level to help policymakers prioritize key areas of actions to protect the household from 100% financial hardship for seeking health care as part of universal health coverage.ObjectivesWe first estimated the costs of illnesses among a population in urban Bangladesh, and then assessed the household financial burden associated with these illnesses.MethodA cross-sectional survey of 1593 randomly selected households was carried out in Bangladesh (urban area of Rajshahi city), in 2011. Catastrophic expenditure was estimated at 40% threshold of household capacity to pay. We employed the Bayesian two-stage hurdle model and Bayesian logistic regression model to estimate age-adjusted average cost and the incidence of household financial catastrophe for each illness, respectively.ResultsOverall, approximately 45% of the population of Bangladesh had at least one episode of illness. The age-sex-adjusted average medical expenses and catastrophic health care expenditure among the households were TK 621 and 8%, respectively. Households spent the highest amount of money 7676.9 on paralysis followed by liver disease (TK 2695.4), injury (TK 2440.0), mental disease (TK 2258.0), and tumor (TK 2231.2). These diseases were also responsible for higher incidence of financial catastrophe. Our study showed that 24% of individuals who suffered typhoid incurred catastrophic expenditure followed by liver disease (12.3%), tumor (12.1%), heart disease (8.4%), injury (7.9%), mental disease (7.9%), cataract (7.1%), and paralysis (6.5%).ConclusionThe study findings suggest that chronic illnesses were responsible for high costs and high catastrophic expenditures in Bangladesh. Effective risk pooling mechanism might reduce household financial burden related to illnesses. Chronic illness related to NCDs is the major cause of OOP. It is also important to consider prioritizing vulnerable population by subsidizing the high health care cost for some of the chronic illnesses.