Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand
Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand
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DOI：
10.2471/blt.06.033720
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发表时间：
2007-08-01
期刊：
影响因子：
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通讯作者：
Prakongsai, Phusit
中科院分区：
文献类型：
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作者：
Limwattananon, Supon;Tangcharoensathien, Viroj;Prakongsai, Phusit
目的估计家庭自付引起的灾难性支出和损失的发生率并描述其特征，方法对2000年全民医保实施前全国代表性家庭的社会经济学调查数据进行分析（n = 24 747）和UC后在2002年（n = 34 785）和2004年（n = 34 843）。结果使用住院治疗的家庭经历灾难性的支出最频繁（31.0%，在2000年，分别为15.1%和14.6%，在2002年和2004年）。在UC后的两个时期，私立医院住院服务的灾难性支出发生率为2002年的32.1%和2004年的27.8%。对于那些在地区医院接受住院治疗的人来说，相应的灾难性支出数字在2002年和2004年分别为6.5%和7.3%。2002年至2004年，私立医院门诊服务的灾难性支出发生率从27.9%上升到28.5%。2000年，在实行全民覆盖之前，使用私立医院并面临灾难性支出的泰国家庭比例为35.8%的住院治疗和36.0%的门诊治疗。贫困家庭的贫困程度有所增加，因为住院服务费用在2002年增加了84.0%，2004年增加了71.5%，2000年增加了95.6%。自付费用的相对增加被发现在98.8%至100%的那些谁是穷人支付给私立医院，无论类型的care.Conclusion使用住院服务的家庭，特别是在私立医院，更有可能面临灾难性的支出和自付费用。使用UC福利计划未涵盖的服务和绕过指定的提供者（根据人头合同模式，如果没有适当的转介，将被禁止）是灾难性支出和浪费的主要原因。
Objective To estimate the incidence and describe the profile of catastrophic expenditures and impoverishment due to household out-of-pocket payments, comparing the periods before and after the introduction of universal health care coverage (UC).Methods Secondary data analyses of socioeconomic surveys on nationally representative households pre-UC in 2000 (n = 24 747) and post-UC in 2002 (n = 34 785) and 2004 (n = 34 843).Findings Households using inpatient care experienced catastrophic expenditures most often (31.0% in 2000, compared with 15.1 % and 14.6% in 2002 and 2004, respectively). During the two post-UC periods, the incidence of catastrophic expenditures for inpatient services at private hospitals was 32.1 % for 2002 and 27.8% for 2004. For those using inpatient care at district hospitals, the corresponding catastrophic expenditures figures were 6.5% and 7.3% in 2002 and 2004, respectively. The catastrophic expenditures incidence for outpatient services from private hospitals moved from 27.9% to 28.5% between 2002 and 2004. In 2000, before universal coverage was introduced, the percentages of Thai households who used private hospitals and faced catastrophic expenditures were 35.8% for inpatient care and 36.0% for outpatient care. Impoverishment increased for poor households because of payments for inpatient services by 84.0% in 2002, by 71.5% in 2004 and by 95.6% in 2000. The relative increase in out-of-pocket impoverishment was found in 98.8% to 100% of those who were poor following payments made to private hospitals, regardless of type of care.Conclusion Households using inpatient services, especially at private hospitals, were more likely to face catastrophic expenditures and impoverishment from out-of-pocket payments. Use of services not covered by the UC benefit package and bypassing the designated providers (prohibited under the capitation contract model without proper referrals) are major causes of catastrophic expenditures and impoverishment.