Abegunde Dele Olawale, Stanciole Anderson E
World Health Organization, Chronic diseases and health promotion, 20 Avenue Appia, 1211 Geneva, Switzerland.
Soc Sci Med. 2008 Jun;66(11):2296-307. doi: 10.1016/j.socscimed.2008.01.041. Epub 2008 Mar 7.
The epidemiological burden of chronic diseases is increasing worldwide and there is very little empirical evidence regarding the economic impact of chronic diseases on individuals and households. The primary objective of this paper is to explore the evidence on how chronic diseases affect household healthcare expenditure, non-health consumption, labour (earned) income, and to demonstrate how transfers may provide some insurance against shocks from chronic diseases. We have explicated a two-part Heckit model on household level data obtained from the Living Standard Measurement Surveys (LSMS) from Russia to control for nontrivial proportion of zeros in the dependent variables, skewed distribution of expenditure data and endogeneity. The results indicate that chronic diseases are significantly associated with higher levels of household healthcare expenditure in Russia and productivity losses reflected by reduced labour supply and reduced household labour income. Non-healthcare expenditure also increased. Results suggest that households are able to insure non-health consumption against chronic diseases, possibly from transfers, which also increased. In addition, socioeconomic status indicators significantly explained the impact of chronic diseases on households. Insurance and higher average education in households were associated with higher healthcare expenditure. Household transfers were significant in Russia despite an appreciable level of insurance cover. We conclude that households depend on informal coping mechanisms in the face of chronic diseases, irrespective of insurance cover. These results have implications for policies regarding the financing of treatment and control of chronic diseases in the country studied.
慢性病的流行病学负担在全球范围内不断增加，而关于慢性病对个人和家庭经济影响的实证证据却非常少。本文的主要目的是探讨慢性病如何影响家庭医疗支出、非医疗消费、劳动力（赚取）收入的证据，并展示转移支付如何为慢性病带来的冲击提供一定的保障。我们根据从俄罗斯生活水平测量调查（LSMS）获得的家庭层面数据，构建了一个两部分的赫克托模型，以控制因变量中大量的零值、支出数据的偏态分布和内生性。结果表明，在俄罗斯，慢性病与家庭医疗支出水平较高以及劳动力供应减少和家庭劳动收入降低所反映的生产力损失显著相关。非医疗支出也有所增加。结果表明，家庭能够通过转移支付（转移支付也有所增加）为慢性病的非医疗消费提供保障。此外，社会经济地位指标显著解释了慢性病对家庭的影响。家庭中的保险和较高的平均教育水平与较高的医疗支出相关。尽管保险覆盖水平较高，但俄罗斯的家庭转移支付仍然显著。我们得出结论，无论保险覆盖情况如何，面对慢性病时家庭都依赖非正式应对机制。这些结果对所研究国家慢性病治疗和控制的融资政策具有启示意义。
