Xu Ke, Evans David B, Kawabata Kei, Zeramdini Riadh, Klavus Jan, Murray Christopher J L
Evidence and Information for Policy, World Health Organization, 20 Avenue Appia, CH-1211 27, Geneva, Switzerland.
Lancet. 2003 Jul 12;362(9378):111-7. doi: 10.1016/S0140-6736(03)13861-5.
Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. Yet catastrophic expenditure is not rare. We investigated the extent of catastrophic health expenditure as a first step to developing appropriate policy responses.
We used a cross-country analysis design. Data from household surveys in 59 countries were used to explore, by regression analysis, variables associated with catastrophic health expenditure. We defined expenditure as being catastrophic if a household's financial contributions to the health system exceed 40% of income remaining after subsistence needs have been met.
The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries. Catastrophic spending rates were highest in some countries in transition, and in certain Latin American countries. Three key preconditions for catastrophic payments were identified: the availability of health services requiring payment, low capacity to pay, and the lack of prepayment or health insurance.
People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection. Increase in the availability of health services is critical to improving health in poor countries, but this approach could raise the proportion of households facing catastrophic expenditure; risk protection policies would be especially important in this situation.
长期以来，卫生政策制定者一直关注保护人们免受健康不佳导致灾难性财务支出及随后贫困的可能性。然而，灾难性支出并不罕见。我们调查了灾难性卫生支出的程度，作为制定适当政策应对措施的第一步。
我们采用了跨国分析设计。利用59个国家家庭调查的数据，通过回归分析来探究与灾难性卫生支出相关的变量。如果一个家庭对卫生系统的财务贡献超过满足基本生活需求后剩余收入的40%，我们就将该支出定义为灾难性支出。
各国面临自付医疗费用灾难性支出的家庭比例差异很大。一些转型国家和某些拉丁美洲国家的灾难性支出率最高。确定了灾难性支出的三个关键先决条件：需要付费的卫生服务的可及性、支付能力低以及缺乏预付或医疗保险。
通过减少卫生系统对自付费用的依赖并提供更多财务风险保护，可以保护人们，尤其是贫困家庭，免受灾难性卫生支出的影响。增加卫生服务的可及性对于改善贫穷国家的健康状况至关重要，但这种方法可能会提高面临灾难性支出的家庭比例；在这种情况下，风险保护政策将尤为重要。
