Protecting the poor? Impact of the national health equity fund on utilization of government health services in Cambodia, 2006-2013
Protecting the poor? Impact of the national health equity fund on utilization of government health services in Cambodia, 2006-2013
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DOI：
10.1136/bmjgh-2019-001679
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发表时间：
2019-11-01
影响因子：
8.1
通讯作者：
Lo, Veasnakiry
中科院分区：
文献类型：
--
作者：
Annear, Peter Leslie;Lee, John Tayu;Lo, Veasnakiry
简介 柬埔寨的健康公平基金（HEF）是该国最重要的社会保障计划，覆盖了最贫困的人口——占全国人口的五分之一。在过去二十年中，HEF 系统从最初的两个卫生区扩大到覆盖全国的公共卫生设施。这是第一项考察 HEF 对公共卫生设施利用影响的全国性研究。方法我们首先使用行政 HEF 操作数据集调查了国家 HEF 人口覆盖水平和符合 HEF 资格的成员的卫生服务使用情况。其次，通过对 2006 年至 2013 年期间每月例行利用率统计数据进行多级间断时间序列分析，我们评估了 HEF 对医院和健康中心利用率的影响。 结果 在某一年中，HEF 受益人使用医院服务的比例 (4.6%) 似乎超过了一般人群的比例 (3.3%)。 HEF 的引入与以下因素相关：HC 每月咨询次数的显着水平变化，随后时间趋势的逐渐斜率增加以及每月交付次数的显着水平变化。总体而言，这相当于第一年咨询次数净增长 15.6%，交付量净增长 5.3%。在 RH 处：RH 住院病例数发生显着水平变化，随后呈持续斜率增加；门诊就诊数量和新生儿分娩总数显着增加。总体而言，这相当于第一年住院病例净增加 47.9%，门诊病例净增加 24.1%，分娩净增加 31.4%。 结论 HEF 计划的实施与穷人对初级和二级护理服务的利用增加有关。
Introduction Cambodia's health equity fund (HEF) is the country's most significant social security scheme, covering the poorest one--fifth of the national population. During the last two decades, the HEF system was scaled up from an initial two health districts to national coverage of public health facilities. This is the first national study to examine the impact of the HEF on the utilisation of public health facilities.Methods We first investigated the level of national HEF population coverage and health service use made by HEF eligible members using an administrative HEF operational dataset. Second, through multilevel interrupted time series analysis of routine monthly utilisation statistics during 2006-2013, we evaluated the impact of the HEF on hospital and health centre utilisation.Results The proportion of HEF beneficiaries using hospital services in a given year (4.6%) appeared to exceed rates in the general population (3.3%). The introduction of the HEF was associated with: a significant level change in the monthly number of consultations at HCs followed by a gradual slope increase in time trend and a significant level change in the monthly number of deliveries. Overall, this was equivalent to a 15.6% net increase in number of consultations and 5.3% in deliveries in the first year. At RHs: a significant level change in the number of RH inpatient cases, followed by a sustained slope increase; a significant slope increase in the number of outpatient consultations and in the overall number of newborn deliveries. Overall, this was equivalent to a 47.9% net increase in inpatient cases, 24.1% in outpatient cases and 31.4% in deliveries in the first year.Conclusion The implementation of the HEF scheme was associated with increased utilisation of primary and secondary care services by the poor.