The economic impact of chronic diseases: How do households respond to shocks? Evidence from Russia
The economic impact of chronic diseases: How do households respond to shocks? Evidence from Russia
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DOI：
10.1016/j.socscimed.2008.01.041
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发表时间：
2008-06-01
影响因子：
5.4
通讯作者：
Stanciole, Anderson E.
中科院分区：
文献类型：
--
作者：
Abegunde, Dele Oawale;Stanciole, Anderson E.
慢性病的流行病学负担在世界范围内不断增加，但关于慢性病对个人和家庭的经济影响的经验证据却很少。本文的主要目的是探索慢性病如何影响家庭医疗保健支出、非健康消费、收入（赚取的）收入的证据，并证明转移支付如何提供一些针对慢性病冲击的保险。我们对从俄罗斯生活水平测量调查（LSMS）获得的家庭水平数据阐述了一个由两部分组成的 Heckit 模型，以控制因变量中非平凡零的比例、支出数据的偏态分布和内生性。结果表明，慢性病与俄罗斯家庭医疗保健支出水平较高以及因食品供应减少和家庭劳动收入减少而导致的生产力损失显着相关。非医疗保健支出也有所增加。结果表明，家庭能够确保非健康消费免受慢性病的影响，这可能来自转移支付，而转移支付也有所增加。此外，社会经济地位指标显着解释了慢性病对家庭的影响。家庭保险和较高的平均教育程度与较高的医疗保健支出相关。尽管保险覆盖范围相当大，但俄罗斯的家庭转移仍然很严重。我们的结论是，无论保险范围如何，家庭在面对慢性病时都依赖非正式的应对机制。这些结果对所研究国家的慢性病治疗和控制融资政策具有影响。 (C) 2008 年，爱思唯尔有限公司出版。
The epidemiological burden of chronic diseases is increasing worldwide and there is very little empirical evidence regarding the economic impact of chronic diseases on individuals and households. The primary objective of this paper is to explore the evidence on how chronic diseases affect household healthcare expenditure, non-health consumption, tabour (earned) income, and to demonstrate how transfers may provide some insurance against shocks from chronic diseases. We have explicated a two-part Heckit model on household level data obtained from the Living Standard Measurement Surveys (LSMS) from Russia to control for nontrivial proportion of zeros in the dependent variables, skewed distribution of expenditure data and endogeneity. The results indicate that chronic diseases are significantly associated with higher levels of household healthcare expenditure in Russia and productivity losses reflected by reduced tabour supply and reduced household labour income. Non-healthcare expenditure also increased. Results suggest that households are able to insure non-health consumption against chronic diseases, possibly from transfers, which also increased. In addition, socioeconomic status indicators significantly explained the impact of chronic diseases on households. Insurance and higher average education in households were associated with higher healthcare expenditure. Household transfers were significant in Russia despite an appreciable level of insurance cover. We conclude that households depend on informal coping mechanisms in the face of chronic diseases, irrespective of insurance cover. These results have implications for policies regarding the financing of treatment and control of chronic diseases in the country studied. (C) 2008 Published by Elsevier Ltd.