Elgazzar Heba
Personal Social Services Research Unit, The London School of Economics and Political Science, UK.
Health Econ Policy Law. 2009 Oct;4(Pt 4):445-78. doi: 10.1017/S1744133109004939. Epub 2009 Mar 3.
In middle-income Arab countries such as Egypt and Lebanon, income-associated equity in health care remains an elusive policy objective in part due to a relatively high reliance on out-of-pocket payments in financing care. This article examines the effect of income on the use of outpatient and inpatient health care services in Egypt and Lebanon using econometric analysis of cross-sectional data from the World Health Organization. In light of noticeable differences in income and public financing arrangements, these two countries serve as interesting case studies. Multivariate regression results suggest that Egyptian respondents were more likely to use health services than their Lebanese counterparts, holding all else constant, and that this effect was particularly evident for outpatient care. A higher income and insurance increased the likelihood of outpatient use more so than inpatient use, with these effects more pronounced in Lebanon. Overall, lower-income groups tended to report having worse health levels and paying more out-of-pocket on health care as a share of income than did higher-income groups. At the same time, these socioeconomic disparities in health appeared to be greater in Lebanon than in Egypt. Economic barriers to the use of health services are discussed within the context of health financing policy reforms aimed at improving equity in access to care in countries such as Egypt and Lebanon.
在埃及和黎巴嫩等中等收入阿拉伯国家，医疗保健方面与收入相关的公平性仍是一个难以实现的政策目标，部分原因在于医疗保健融资相对高度依赖自费支付。本文利用世界卫生组织横断面数据的计量经济学分析，研究收入对埃及和黎巴嫩门诊及住院医疗服务使用情况的影响。鉴于收入和公共融资安排存在显著差异，这两个国家成为有趣的案例研究对象。多元回归结果表明，在其他条件不变的情况下，埃及受访者比黎巴嫩受访者更有可能使用医疗服务，且这种影响在门诊护理方面尤为明显。较高的收入和保险对门诊服务使用可能性的增加幅度大于住院服务，这些影响在黎巴嫩更为显著。总体而言，低收入群体往往报告健康水平较差，且作为收入一部分的医疗保健自费支出比高收入群体更多。与此同时，黎巴嫩的这些健康方面的社会经济差距似乎比埃及更大。本文在旨在改善埃及和黎巴嫩等国医疗服务可及性公平性的卫生融资政策改革背景下，讨论了使用医疗服务的经济障碍。
