Do Mai, Soelaeman Rieza, Hotchkiss David R
Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA,
Matern Child Health J. 2015 Apr;19(4):755-63. doi: 10.1007/s10995-014-1561-5.
Wealth-related disparities in the use of reproductive health services remain a substantial problem in many low- and middle-income countries. Very few studies have attempted to explain such inequalities through decomposition of the contributions made by various individual- and household-level factors. This study aims to: (1) assess the degree of wealth-related inequality and inequity in the use of institutional delivery services in selected low- and middle-income countries, and (2) to explain wealth-related inequity through decomposition by the contributions made by various components, including health insurance coverage. Data come from Demographic and Health Surveys in three countries: Ghana, Rwanda, and the Philippines. Concentration indices are used to calculate inequality and horizontal inequity in service utilization. Multivariate methods are used to decompose inequity. Findings indicate a moderate to high degree of inequity in institutional delivery service use in all study countries. The study provides some evidence of the contribution of health insurance to increased wealth-related inequity in the use of institutional delivery services, although having health insurance was also associated with increased utilization of services. Results suggest that increased health insurance coverage does not automatically translate to lower wealth-related inequity in service utilization. Inequities in service utilization exist if there are still inequities in the health insurance status. The study advocates for expanding health insurance coverage, particularly among the poor to reduce inequity in insurance coverage and increase service utilization.
在许多低收入和中等收入国家，与财富相关的生殖健康服务利用差异仍是一个重大问题。极少有研究试图通过分解各种个人和家庭层面因素的贡献来解释此类不平等现象。本研究旨在：（1）评估选定的低收入和中等收入国家在机构分娩服务利用方面与财富相关的不平等和不公平程度，以及（2）通过分解包括医疗保险覆盖情况在内的各种组成部分的贡献来解释与财富相关的不公平现象。数据来自加纳、卢旺达和菲律宾三个国家的人口与健康调查。集中指数用于计算服务利用方面的不平等和横向不公平。采用多变量方法分解不公平现象。研究结果表明，所有研究国家在机构分娩服务利用方面都存在中度到高度的不公平现象。该研究提供了一些证据，证明医疗保险对机构分娩服务利用中与财富相关的不公平现象加剧有一定作用，尽管拥有医疗保险也与服务利用率提高有关。结果表明，扩大医疗保险覆盖范围并不会自动转化为服务利用中与财富相关的不公平现象减少。如果医疗保险状况仍然存在不公平现象，那么服务利用方面的不公平现象就会存在。该研究主张扩大医疗保险覆盖范围，特别是在贫困人口中，以减少保险覆盖方面的不公平现象并提高服务利用率。
