The poor pay more: Health-related inequality in Thailand
The poor pay more: Health-related inequality in Thailand
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DOI：
10.1016/s0277-9536(96)00287-0
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发表时间：
1997-06-01
影响因子：
5.4
通讯作者：
Mills, A
中科院分区：
文献类型：
--
作者：
Pannarunothai, S;Mills, A
本文探讨了泰国大城市地区卫生服务平等需求和公平的自付费用的利用。来自家庭健康访谈调查的数据被用来探索感知的发病率，利用各种治疗来源，和自付的模式。医疗福利/保险所反映的获得医疗保健的经济状况似乎影响到报告的患病率和住院率。在这个人口稠密的城市地区，社会经济地位较低的群体严重缺乏获得保健的机会并不是主要问题，因为人们可以根据自己的支付能力和意愿选择和使用替代保健服务。然而，其必然结果是按收入五分位数和人均计算的自付保健支出模式不公平。与更有特权的群体相比，贫困阶层更有可能自掏腰包支付健康问题，而且支付的费用与家庭收入不成比例。此外，贫困者最不可能享受政府的医疗福利计划，这与公务员形成了鲜明对比，公务员自掏腰包支付的费用较少，也不向其医疗福利基金缴款，私营保健部门（私人诊所和私人医院）是城市居民门诊和住院服务的主要保健提供者。本文讨论了改善卫生保健支付系统公平性的短期和长期政策选择。(C)1997 Elsevier Science Ltd.
This paper examines the equality of utilization for equal need and equity of out-of-pocket expenditure for health services in a large urban area in Thailand. Data from a household health interview survey were used to explore patterns of perceived morbidity, utilization of various treatment sources, and out-of-pocket payment. Financial access to health care, as reflected in medical benefit/insurance cover, appeared to influence reported illness and hospitalization rates. Gross lack of access to health care amongst lower socio-economic groups was not the main problem in this densely populated urban area because people could choose and use alternative health services according to their ability and willingness to pay. The corollary, however, was an inequitable pattern of out-of-pocket health expenditure by income quintile and per capita. The underprivileged were more likely to pay out of their own pocket for their health problems, and to pay out of proportion to their household income when compared with more privileged groups. Furthermore, the underprivileged were least likely to be covered by government health benefit schemes, in contrast in particular to civil servants, who paid less out of pocket and did not contribute to their medical benefit fund. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Policy options for the short and long term to improve the equity of payment systems for health care ale discussed. (C) 1997 Elsevier Science Ltd.