Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis.
Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis.
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DOI：
10.1186/s12939-021-01555-7
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发表时间：
2021-09-29
影响因子：
4.8
通讯作者：
Moreno-Serra R
中科院分区：
文献类型：
--
作者：
León-Giraldo S;Cuervo-Sánchez JS;Casas G;González-Uribe C;Kreif N;Bernal O;Moreno-Serra R
本研究分析了哥伦比亚Meta受冲突影响地区灾难性卫生支出的不平等，以及2016年与FARC-EP游击队签署哥伦比亚和平协议之前和之后导致灾难性支出存在和变化的社会经济因素。该研究使用了2014年和2018年在哥伦比亚Meta的1309个家庭进行的调查结果，该地区历史上受到武装冲突的影响。我们将灾难性支出定义为超过家庭支付能力20%的卫生支出。我们通过Oaxaca-Blinder变化分解方法分解了灾难性支出不平等的变化。灾难性支出的发生率在2014年至2018年期间略有增加，从29.3%增加到30.7%。通过集中指数（CI）衡量的灾难性支出的不平等也从2014年（CI：-0.152）增加到2018年（CI：-0.232）。结果表明，社会经济群体之间灾难性支出的差异主要归因于特定社会人口变量的影响增加，例如生活在农村地区，中年人，生活在受冲突影响的地区，或呈现任何类型的精神和身体残疾。冲突降级和和平协定可能促进了低收入群体获得保健服务，特别是在受冲突影响严重的地区。因此，这可能导致较高水平的自付支出，因此，与较高收入群体相比，较低收入群体经历灾难性支出的可能性更大。因此，结果表明，必须制定政策，保证受冲突影响地区的人民获得保健服务，同时尽量减少不同社会经济群体之间可能引起的自付医疗费用不平等。
The present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016. The study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method. The incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3 to 30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability. Conflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.
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影响因子：
4.8
作者：
Amaya-Lara JL
通讯作者：
Amaya-Lara JL
影响因子：
3.2
作者：
Kavosi, Zahra;Rashidian, Arash;Arab, Mohammad
通讯作者：
Arab, Mohammad
影响因子：
3.2
作者：
Ergo, Alex;Htoo, Thant Sin;Royono, Rivandra
通讯作者：
Royono, Rivandra
影响因子：
2.2
作者：
Grosskopf, S.;Self, S.;Zaim, O.
通讯作者：
Zaim, O.
影响因子：
4.8
作者：
Buigut S;Ettarh R;Amendah DD
通讯作者：
Amendah DD