Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998
Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998
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DOI：
10.1002/hec.776
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发表时间：
2003-11-01
期刊：
影响因子：
2.1
通讯作者：
van Doorslaer, E
中科院分区：
文献类型：
--
作者：
Wagstaff, A;van Doorslaer, E
本文提出并比较了衡量医疗保健支付公平性的两种门槛方法，一种要求付款不超过预付款收入的预先指定比例，另一种要求它们不会导致家庭陷入贫困。我们制定了“灾难”指数，以反映灾难的强度及其发生率，并让分析师能够了解灾难性支出在贫困家庭中不成比例地发生的程度。还制定了衡量贫困影响强度和发生率的指标。这些论点和方法通过越南 1993 年和 1998 年自费支付的数据进行了实证说明。考虑到 1998 年该国 80% 的医疗支出是自费支付的，这并不是一个无趣的应用。我们发现“灾难性”支付的发生率和强度（无论是在预付款收入还是支付能力方面）在 1993 年至 1998 年间都有所下降，而且“灾难”的发生率和强度都不再集中在穷人身上。我们还发现，自付费用造成的贫困影响的发生率和强度在相关时期有所下降。最后，我们发现，自付费用对贫困的影响主要是由于贫困者变得更加贫困，而不是非贫困者变穷，而且增加贫困的不是与住院护理相关的费用，而是非医院支出。版权所有 (C) 2003 John Wiley Sons, Ltd.
This paper presents and compares two threshold approaches to measuring the fairness of health care payments, one requiring that payments do not exceed a pre-specified proportion of pre-payment income, the other that they do not drive households into poverty. We develop indices for 'catastrophe' that capture the intensity of catastrophe as well as its incidence and also allow the analyst to capture the degree to which catastrophic payments occur disproportionately among poor households. Measures of poverty impact capturing both intensity and incidence are also developed. The arguments and methods are empirically illustrated with data on out-of-pocket payments from Vietnam in 1993 and 1998. This is not an uninteresting application given that 80% of health spending in that country was paid out-of-pocket in 1998. We find that the incidence and intensity of 'catastrophic' payments - both in terms of pre-payment income as well as ability to pay - were reduced between 1993 and 1998, and that both incidence and intensity of 'catastrophe' became less concentrated among the poor. We also find that the incidence and intensity of the poverty impact of out-of-pocket payments diminished over the period in question. Finally, we find that the poverty impact of out-of-pocket payments is primarily due to poor people becoming even poorer rather than the non-poor being made poor, and that it was not expenses associated with inpatient care that increased poverty but rather non-hospital expenditures. Copyright (C) 2003 John Wiley Sons, Ltd.