Detecting changes in financial protection: creating evidence for policy in Estonia
Detecting changes in financial protection: creating evidence for policy in Estonia
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DOI：
10.1093/heapol/czl026
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发表时间：
2006-11-01
影响因子：
3.2
通讯作者：
Kutzin, Joseph
中科院分区：
文献类型：
--
作者：
Habicht, Jarno;Xu, Ke;Kutzin, Joseph
94%的爱沙尼亚人口享受公共医疗保险，但私人支出无论是实际支出还是占医疗支出总额的百分比都在迅速增长。迄今为止，很少有人关注这可能对民众的财务保护产生的影响。在许多低收入和中等收入国家，自付费用占私人支出的大部分，可能使人们陷入贫困，而且更普遍地对一些家庭造成过高的负担。因此，政府监测自付费用对健康的影响非常重要。本文旨在以爱沙尼亚为例，说明如果有家庭预算调查数据，监测人口的财务保护并不是一项复杂的任务。此外，通过将这些数据的简单统计分析与对国家卫生系统的深入了解相结合，可以对人口覆盖范围限制的性质进行相当详细的诊断。这样可以呈现易于解释的结果，从而提高政策制定者的认识，并有助于制定适当的政策应对措施。通过使用爱沙尼亚 1995 年、2001 年和 2002 年的家庭预算调查，我们发现，用于医疗保健的支出超过其支付能力 20% 的家庭比例从 1995 年的 3.4% 增加到 2002 年的 7.4%，2002 年则增加到 1.3%。由于支付医疗费用，人们陷入贫困。逻辑回归有助于识别最危险的人群：属于贫困家庭并在药品上花费大量资金的老年患者。这项可以复制的研究确实提高了政策制定者对爱沙尼亚多年来金融保护变化的认识。
Ninety-four per cent of the Estonian population is covered by public health insurance, but private expenditure has been increasing quickly both in real terms and as a percentage of total health expenditure. To date, little attention has been given to the impact this could have on the population's financial protection. Out-of-pocket payments, which account for the bulk of the private expenditure in many low- and middle-income countries, can push people into poverty and more generally represent too high a burden for some households. It is therefore very important that governments monitor the impact of out-of-pocket payments on health. Using an example from Estonia, this paper aims to illustrate that, if household budget survey data are available, monitoring a population's financial protection is not a complex undertaking. Further, by combining simple statistical analyses of these data with a good knowledge of a country's health system, it is possible to give a fairly detailed diagnostic of the nature of the population's coverage limitation. This allows for the presentation of easily interpretable results that can raise awareness among policy-makers and help to target adequate policy responses.Using Estonian household budget surveys from 1995, 2001 and 2002, we show that the proportion of households who spend more than 20% of their capacity to pay on health increased from 3.4% in 1995 to 7.4% in 2002 and that in 2002, 1.3% of the population fell into poverty because of health payments. Logistic regression helps in identifying the population most at risk: elderly patients who belong to poor households and spend high amounts on medicines. This study, which can be replicated, did raise awareness among policy-makers about the changes in financial protection over the years in Estonia.