越南医疗保健扶贫政策是否有利于老年贫困人口？

Has Vietnam Health care funds for the poor policy favored the elderly poor?

机构信息

Institute of Health Economics, #1200 10405 Jasper Ave, Edmonton, Alberta, T5J 3N4, Canada.

出版信息

BMC Health Serv Res. 2012 Sep 22;12:333. doi: 10.1186/1472-6963-12-333.

DOI:10.1186/1472-6963-12-333

PMID:22999637

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3514242/

Abstract

BACKGROUND

The elderly population is increasing in Vietnam. Access to health services for the elderly is often limited, especially for those in rural areas. User fees at public health care facilities and out-of-pocket payments for health care services are major barriers to access. With the aim of helping the poor access public health care services and reduce health care expenditures (HCE), the Health Care Funds for the Poor policy (HCFP) was implemented in 2002. The aim of this study is to investigate the impacts of this policy on elderly households.

METHODS

Elderly households were defined as households which have at least one person aged 60 years or older. The impacts of HCFP on elderly household HCE as a percentage of total expenditure and health care utilization were assessed by a double-difference propensity score matching method using panel data of 3,957 elderly households in 2001, 2003, 2005 and 2007, of which 509 were classifies as "treated" (i.e. covered by the policy). Variables included in a logistic regression for estimating the propensity scores to match the treated with the control households, were household and household-head characteristics.

RESULTS

In the first time period (2001-2003) there were no significant differences between treated and controls. This can be explained by the delay in implementing the policy by the local governments. In the second (2001-2005) and third period (2001-2007) the utilizations of Communal Health Stations (CHS) and go-to-pharmacies were significant. The treated were using CHS and pharmacies more between 2001 and 2007 while control households decreased their use.

CONCLUSION

The main findings suggest HCFP met some goals but not all in the group of households having at least one elderly member. Utilization of CHS and pharmacies increased while the change in HCE as a proportion of total expenditures was not significant. To some extent, private health care and self-treatment are replaced by more utilization of CHS, indicating the poor elderly are better off. However, further efforts are needed to help them access higher levels of public health care (e.g. district health centers and provincial/central hospitals) and to reduce their HCE.

摘要

背景

越南的老年人口正在增加。老年人获得医疗服务往往受到限制，尤其是在农村地区。公共医疗保健机构的用户费用和医疗服务的自费支付是获得医疗服务的主要障碍。为了帮助贫困人口获得公共医疗保健服务并减少医疗保健支出（HCE），2002 年实施了贫困医疗保健基金政策（HCFP）。本研究旨在调查该政策对老年家庭的影响。

方法

老年家庭被定义为至少有一名 60 岁或以上成员的家庭。使用面板数据（2001 年、2003 年、2005 年和 2007 年的 3957 个老年家庭），采用双重差分倾向得分匹配法评估 HCFP 对老年家庭 HCE 占总支出的百分比和医疗保健利用率的影响，其中 509 个家庭被归类为“治疗组”（即受政策覆盖）。用于估计倾向得分以匹配治疗组和对照组家庭的逻辑回归中包含的变量是家庭和家庭负责人的特征。

结果

在第一时间段（2001-2003 年），治疗组和对照组之间没有显著差异。这可以解释为地方政府延迟实施该政策。在第二（2001-2005 年）和第三时期（2001-2007 年），社区卫生站（CHS）和去药店的利用率显著提高。在 2001 年至 2007 年期间，治疗组使用 CHS 和药店的频率更高，而对照组家庭则减少了使用。

结论

主要发现表明，HCFP 在至少有一名老年成员的家庭组中实现了一些目标，但并非全部。CHS 和药店的利用率有所增加，而 HCE 占总支出的比例变化不显著。在一定程度上，私人医疗保健和自我治疗被更多地利用 CHS 所取代，表明贫困的老年人状况更好。然而，仍需要进一步努力帮助他们获得更高水平的公共医疗保健（例如，区卫生中心和省/中央医院），并减少他们的 HCE。