National Institute of Health and Family Welfare, New Delhi, India.
Health Policy Plan. 2012 May;27(3):213-21. doi: 10.1093/heapol/czr029. Epub 2011 Apr 12.
Protecting households from high out-of-pocket (OOP) payments for health care is an important health system goal. High OOP payments can push households into poverty and make them vulnerable to catastrophic health expenditures. This study, based in India, aims to: (a) estimate OOP payments for health and related impoverishment across economic groups; (b) decompose OOP payments and relate the contribution of their components to impoverishment; and (c) examine how well recently introduced national insurance schemes meant for the poor are able to provide financial protection. The analysis of nationally representative data from India shows that 3.5% of the population fall below the poverty line and 5% households suffer catastrophic health expenditures. The poverty deepening impact of OOP payments was at a maximum in people below the poverty line in comparison with those above (Rs. 10.45 vs. Rs. 1.50, respectively). Medicines constitute the main share (72%) of total OOP payments. This share reaches 82% for outpatient care, compared with 42% for inpatient care. Removing OOP payments for inpatient care leads to a negligible fall in the poverty headcount ratio and poverty gap. However, if OOP payments for either medicines or outpatient care are removed then only 0.5% people fall into poverty due to spending on health. These findings suggest that insurance schemes which cover only hospital expenses, like those being rolled out nationally in India, will fail to adequately protect the poor against impoverishment due to spending on health. Further, issues related to identifying the poor and their targeting also constrain the scheme's impact. A broader coverage of benefits, to include medicines and outpatient care for the poor and near poor (i.e. those just above the poverty line), is necessary to achieve significant protection from impoverishment.
保障家庭不因医疗保健而产生过高的自付费用（OOP）是一个重要的卫生系统目标。过高的 OOP 支出可能使家庭陷入贫困，并使他们容易遭受灾难性的医疗支出。本研究以印度为背景，旨在：（a）估算不同经济群体的医疗保健 OOP 支出和相关贫困程度；（b）分解 OOP 支出，并将其构成部分对贫困的贡献进行关联；（c）考察最近推出的针对贫困人口的国家保险计划在提供财务保障方面的效果如何。对印度全国代表性数据的分析表明，3.5%的人口处于贫困线以下，5%的家庭遭受灾难性的医疗支出。与收入高于贫困线的人群相比，贫困线以下人群的 OOP 支出对贫困程度的加深影响最大（分别为 Rs.10.45 和 Rs.1.50）。药品构成 OOP 总支出的主要部分（72%）。门诊治疗的这一份额达到 82%，而住院治疗的这一份额为 42%。如果取消住院治疗的 OOP 支出，贫困人口比例和贫困差距的下降幅度可忽略不计。然而，如果取消药品或门诊治疗的 OOP 支出，只有 0.5%的人会因医疗支出而陷入贫困。这些发现表明，仅涵盖住院费用的保险计划，如印度正在全国范围内推出的计划，将无法充分保护贫困人口免受因医疗支出而导致的贫困。此外，与确定贫困人口及其目标定位相关的问题也限制了该计划的效果。为了实现对贫困人口和贫困线边缘人口（即略高于贫困线的人口）的显著保护，需要扩大受益范围，将药品和门诊治疗纳入其中。
