Catastrophic health expenditure and its determinants in Kenya slum communities.
Catastrophic health expenditure and its determinants in Kenya slum communities.
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DOI：
10.1186/s12939-015-0168-9
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发表时间：
2015-05-14
影响因子：
4.8
通讯作者：
Amendah DD
中科院分区：
文献类型：
--
作者：
Buigut S;Ettarh R;Amendah DD
在肯尼亚，60%至80%的城市居民生活在非正规住区（通常称为贫民窟），自付费用占国家卫生支出的三分之一以上。然而，很少有人知道在多大程度上，这些OOP付款与贫民窟的个人或家庭的财务灾难。本文旨在研究肯尼亚城市贫民窟社区灾难性卫生支出的发生率和决定因素。我们使用了一个独特的数据集在肯尼亚的非正式定居点居民和各种方法，家庭OOP支付医疗保健的总支出调整的生存，或收入。我们将OOP超过预定阈值的家庭分类为面临灾难性卫生支出（CHE）的家庭，并使用多变量Logistic回归分析确定CHE的决定因素。结果表明，面临CHE的家庭比例在1.52%和28.38%之间变化很大，这取决于所使用的方法和阈值。一组核心变量被认为是CHE的关键决定因素。一个家庭中有工作的成年人的人数和社会安全网的成员人数似乎减少了灾难性支出的风险。相反，在公立或私立医院寻求治疗会增加CHE的风险。这项研究表明，在肯尼亚的非正规住区的居民面临CHE的很大一部分，可能会放弃他们需要的医疗保健，但不能负担。需要建立风险和费用（保险）共担的机制，以保护贫民窟居民免受卫生保健费用的影响，并改善卫生保健获得和支付方面的公平性。
In Kenya, where 60 to 80% of the urban residents live in informal settlements (frequently referred to as slums), out-of-pocket (OOP) payments account for more than a third of national health expenditures. However, little is known on the extent to which these OOP payments are associated with personal or household financial catastrophe in the slums. This paper seeks to examine the incidence and determinants of catastrophic health expenditure among urban slum communities in Kenya. We use a unique dataset on informal settlement residents in Kenya and various approaches that relate households OOP payments for healthcare to total expenditures adjusted for subsistence, or income. We classified households whose OOP was in excess of a predefined threshold as facing catastrophic health expenditures (CHE), and identified the determinants of CHE using multivariate logistic regression analysis. The results indicate that the proportion of households facing CHE varies widely between 1.52% and 28.38% depending on the method and the threshold used. A core set of variables were found to be key determinants of CHE. The number of working adults in a household and membership in a social safety net appear to reduce the risk of catastrophic expenditure. Conversely, seeking care in a public or private hospital increases the risk of CHE. This study suggests that a substantial proportion of residents of informal settlements in Kenya face CHE and would likely forgo health care they need but cannot afford. Mechanisms that pool risk and cost (insurance) are needed to protect slum residents from CHE and improve equity in health care access and payment.
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影响因子：
4.4
作者：
Galarraga, Omar;Sosa-Rubi, Sandra G.;Salinas-Rodriguez, Aaron;Sesma-Vazquez, Sergio
通讯作者：
Sesma-Vazquez, Sergio
DOI：
10.1007/s11524-011-9595-0
发表时间：
2011-06-01
影响因子：
6.6
作者：
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通讯作者：
Falkingham, Jane
DOI：
10.2471/blt.07.049403
发表时间：
2008-11-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
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作者：
Leive, Adam;Xu, Ke
通讯作者：
Xu, Ke
DOI：
10.2471/blt.06.033720
发表时间：
2007-08-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
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作者：
Limwattananon, Supon;Tangcharoensathien, Viroj;Prakongsai, Phusit
通讯作者：
Prakongsai, Phusit
影响因子：
2.1
作者：
Wagstaff, A;van Doorslaer, E
通讯作者：
van Doorslaer, E