An equity analysis on the household costs of accessing and utilising maternal and child health care services in Tanzania.
An equity analysis on the household costs of accessing and utilising maternal and child health care services in Tanzania.
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DOI：
10.1186/s13561-022-00387-7
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发表时间：
2022-07-08
影响因子：
2.4
通讯作者：
Borghi, Josephine
中科院分区：
文献类型：
--
作者：
Binyaruka, Peter;Borghi, Josephine
关键词：
获得和利用保健的直接成本和时间成本可能会限制获得保健的机会，影响福利损失，并导致灾难性的支出，特别是在最贫穷的家庭中。迄今为止，对时间和运输成本以及这些成本如何在患者、设施和服务类型之间分配的关注有限，特别是在贫困环境中。我们的目标是填补这一知识空白。我们使用了来自坦桑尼亚150家机构的1407名患者的数据。2012年1月通过患者退出访谈收集数据。所有费用都按病人、设施和服务类型分列。数据进行了分析，采用手段，中位数和公平的措施，如公平差距，比率和集中度指数。71%的患者，特别是最贫困和农村患者，步行获得护理。平均旅行时间和费用分别为30分钟和0.41美元。平均轮候时间为47分钟，平均诊症时间为13分钟。平均医疗费用为0.23美元，但只有18%的患者支付医疗费用。最贫穷的农村病人在获得保健服务方面面临大量的时间负担（旅行和等待），但与他们的同行相比，他们的交通和医疗费用较少。患者之间的咨询时间相似。患者花费更多的时间前往公共设施和药房，而产生的交通成本低于访问其他设施类型，但等待和咨询时间在设施类型之间相似。病人在公共设施支付的费用低于私人设施。产后护理和接种疫苗的客户比产前护理客户花费更少的等待和咨询时间，支付更少的医疗费用。我们的研究结果加强了对初级卫生保健进行更多投资的必要性，以减少获得障碍和成本负担，特别是在最贫困的人群中。设施的建设和翻新以及增加医护人员和医疗商品的供应是可以考虑的潜在举措。其他举措可能需要多部门合作。
Direct and time costs of accessing and using health care may limit health care access, affect welfare loss, and lead to catastrophic spending especially among poorest households. To date, limited attention has been given to time and transport costs and how these costs are distributed across patients, facility and service types especially in poor settings. We aimed to fill this knowledge gap. We used data from 1407 patients in 150 facilities in Tanzania. Data were collected in January 2012 through patient exit-interviews. All costs were disaggregated across patients, facility and service types. Data were analysed descriptively by using means, medians and equity measures like equity gap, ratio and concentration index. 71% of patients, especially the poorest and rural patients, accessed care on foot. The average travel time and cost were 30 minutes and 0.41USD respectively. The average waiting time and consultation time were 47 min and 13 min respectively. The average medical cost was 0.23 USD but only18% of patients paid for health care. The poorest and rural patients faced substantial time burden to access health care (travel and waiting) but incurred less transport and medical costs compared to their counterparts. The consultation time was similar across patients. Patients spent more time travelling to public facilities and dispensaries while incurring less transport cost than accessing other facility types, but waiting and consultation time was similar across facility types. Patients paid less amount in public than in private facilities. Postnatal care and vaccination clients spent less waiting and consultation time and paid less medical cost than antenatal care clients. Our findings reinforce the need for a greater investment in primary health care to reduce access barriers and cost burdens especially among the worse-offs. Facility’s construction and renovation and increased supply of healthcare workers and medical commodities are potential initiatives to consider. Other initiatives may need a multi-sectoral collaboration.
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影响因子：
7.2
作者：
Borghi, Josephine;Mayumana, Iddy;Mamdani, Masuma
通讯作者：
Mamdani, Masuma
影响因子：
3.2
作者：
Ataguba JE;Asante AD;Limwattananon S;Wiseman V
通讯作者：
Wiseman V
影响因子：
3.7
作者：
Dror DM;Hossain SA;Majumdar A;Pérez Koehlmoos TL;John D;Panda PK
通讯作者：
Panda PK
影响因子：
2.8
作者：
Ben Ameur A;Ridde V;Bado AR;Ingabire MG;Queuille L
通讯作者：
Queuille L
影响因子：
8.1
作者：
Annear, Peter Leslie;Lee, John Tayu;Lo, Veasnakiry
通讯作者：
Lo, Veasnakiry