Catastrophic expenditure to pay for surgery worldwide: a modelling study.
Catastrophic expenditure to pay for surgery worldwide: a modelling study.
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全球手术费用的灾难性支出：一项建模研究。
DOI：
10.1016/s2214-109x(15)70085-9
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发表时间：
2015-04-27
影响因子：
34.3
通讯作者：
Meara, John G.
中科院分区：
文献类型：
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作者：
Shrime, Mark G.;Dare, Anna J.;Alkire, Blake C.;O'Neill, Kathleen;Meara, John G.
每年大约有1.5亿人面临着单是医疗费用的灾难性支出，还有更多人面临着获得护理的非医疗费用。这一支出中用于外科手术的比例不得而知。由于世界银行提出到2030年消除医疗事故，因此必须量化手术条件对金融灾难的影响，以便任何金融风险保护机制都可以适当地纳入手术。为了确定全球范围内的灾难性支出，由于手术，建立了一个随机模型。每个国家的收入分布，需要手术的可能性，以及手术所面临的医疗和非医疗费用都被纳入其中。进行敏感性分析以检验模型稳健性。3.7 10亿人如果需要手术，就可能面临灾难性的支出。每年，其中3300万人仅因手术费用而陷入财务灾难，4800万人因非医疗费用而陷入财务灾难，导致全球8100万病例。灾难性支出的负担在低收入和中等收入国家最重;在任何国家，这一负担都福尔斯在穷人身上。估计数对灾难性支出和护理费用的定义很敏感。不公平的负担分布是强大的模型假设。全球一半的人口面临手术带来的财务灾难的风险。每年有8 100万人，特别是穷人，因手术条件而面临灾难性的支出，其中不到一半是医疗费用。这些发现强调了在卫生系统设计中为手术提供财务风险保护的必要性。Shrime博士的部分资金来自NIH/NCI R25 CA 92203。
Approximately 150 million individuals face catastrophic expenditure each year from medical costs alone, and many more from the nonmedical costs of accessing care. The proportion of this expenditure arising from surgical conditions is unknown. Because World Bank has proposed eliminating medical impoverishment by 2030, the impact of surgical conditions on financial catastrophe must be quantified so that any financial risk protection mechanisms can appropriately incorporate surgery. To determine the global incidence of catastrophic expenditure due to surgery, a stochastic model was built. The income distribution of each country, the probability of requiring surgery, and the medical and nonmedical costs faced for surgery were incorporated. Sensitivity analyses were run to test model robustness. 3.7 billion people risk catastrophic expenditure if they need surgery. Every year, 33 million of them are driven to financial catastrophe from the costs of surgery alone, and 48 million from nonmedical costs, leading to 81 million cases worldwide. The burden of catastrophic expenditure is highest in low- and middle-income countries; within any country, it falls on the poor. Estimates are sensitive to the definition of catastrophic expenditure and the costs of care. The inequitable burden distribution is robust to model assumptions. Half the global population is at risk of financial catastrophe from surgery. Annually, 81 million individuals, especially the poor, face catastrophic expenditure due to surgical conditions, of which less than half is attributable to medical costs. These findings highlight the need for financial risk protection for surgery in health system design. Partial funding for Dr. Shrime from NIH/NCI R25CA92203.