van Doorslaer Eddy, O'Donnell Owen, Rannan-Eliya Ravi P, Somanathan Aparnaa, Adhikari Shiva Raj, Garg Charu C, Harbianto Deni, Herrin Alejandro N, Huq Mohammed Nazmul, Ibragimova Shamsia, Karan Anup, Ng Chiu Wan, Pande Badri Raj, Racelis Rachel, Tao Sihai, Tin Keith, Tisayaticom Kanjana, Trisnantoro Laksono, Vasavid Chitpranee, Zhao Yuxin
Department of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Lancet. 2006 Oct 14;368(9544):1357-64. doi: 10.1016/S0140-6736(06)69560-3.
Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care.
We obtained data on payments for health care from nationally representative surveys, and subtracted these payments from total household resources. We then calculated the number of individuals with less than the internationally accepted threshold of absolute poverty (US1 dollar per head per day) after making health payments. We also assessed the effect of health-care payments on the poverty gap--the amount by which household resources fell short of the 1 dollar poverty line in these countries.
Our estimate of the overall prevalence of absolute poverty in these countries was 14% higher than conventional estimates that do not take account of out-of-pocket payments for health care. We calculated that an additional 2.7% of the population under study (78 million people) ended up with less than 1 dollar per day after they had paid for health care. In Bangladesh, China, India, Nepal, and Vietnam, where more than 60% of health-care costs are paid out-of-pocket by households, our estimates of poverty were much higher than conventional figures, ranging from an additional 1.2% of the population in Vietnam to 3.8% in Bangladesh.
Out-of-pocket health payments exacerbate poverty. Policies to reduce the number of Asians living on less than 1 dollar per day need to include measures to reduce such payments.
传统的贫困估计未考虑用于支付医疗保健的自付费用。我们旨在通过计算包含和不包含医疗保健自付费用的家庭总资源，重新评估亚洲11个中低收入国家的贫困衡量标准。
我们从具有全国代表性的调查中获取医疗保健支付数据，并从家庭总资源中减去这些支付。然后，我们计算了支付医疗费用后，日均生活费低于国际公认绝对贫困阈值（每人每天1美元）的个体数量。我们还评估了医疗保健支付对贫困差距的影响，即这些国家的家庭资源低于1美元贫困线的金额。
我们对这些国家绝对贫困总体患病率的估计比未考虑医疗保健自付费用的传统估计高14%。我们计算得出，在接受研究的人群中，另有2.7%（7800万人）在支付医疗费用后，日均生活费不足1美元。在孟加拉国、中国、印度、尼泊尔和越南，超过60%的医疗保健费用由家庭自付，我们对贫困的估计远高于传统数据，从越南额外的1.2%人口到孟加拉国的3.8%不等。
医疗保健自付费用加剧了贫困。减少每天生活费不足1美元的亚洲人口数量的政策需要包括减少此类支付的措施。
