Koch Kira Johanna, Cid Pedraza Camilo, Schmid Andreas
Universität Bayreuth, Universitätsstr. 30, Bayreuth, 95447, Germany.
Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 2nd Floor, 8330077 Santiago de Chile, Chile.
Health Policy. 2017 May;121(5):481-494. doi: 10.1016/j.healthpol.2017.02.013. Epub 2017 Mar 2.
Protection against financial risk due to medical spending is an explicit health guarantee within Chile's AUGE health reform. This paper seeks to analyze the degree to which out-of-pocket expenditure still expose Chilean households to financial catastrophe and impoverishment, and to explore inequalities in financial protection.
A systematic literature review was conducted to identify empirical studies analyzing financial protection in Chile. The search included databases as well as grey literature, i.e. governmental and institutional webpages. The indicators are based on the conceptual framework of financial protection, as portrayed in the World Health Report 2013.
We identify n=16 studies that fulfill the inclusion criteria. Empirical studies indicate that 4% of Chilean households faced catastrophic health expenditure defined as out-of-pocket expenditure exceeding 30% of household's capacity to pay, while less than 1% were pushed into poverty in 2012. In contrast to prior studies, recent data report that even publicly insured who should be fully protected from co-payments were affected by catastrophic health expenditure. Also in the private insurance system financial catastrophe is a common risk.
Despite health reform efforts, financial protection is insufficient and varies to the disadvantage of the poor and vulnerable groups. More research is required to understand why current mechanisms are not as effective as expected and to enable according reforms of the insurance system.
防范因医疗支出导致的财务风险是智利全民覆盖（AUGE）医疗改革中一项明确的健康保障措施。本文旨在分析自付费用在多大程度上仍使智利家庭面临财务危机和贫困，并探讨财务保护方面的不平等现象。
进行了一项系统的文献综述，以确定分析智利财务保护情况的实证研究。检索范围包括数据库以及灰色文献，即政府和机构网页。这些指标基于《2013年世界卫生报告》中所描述的财务保护概念框架。
我们确定了16项符合纳入标准的研究。实证研究表明，2012年，4%的智利家庭面临灾难性医疗支出，即自付费用超过家庭支付能力的30%，而陷入贫困的家庭不到1%。与先前的研究不同，近期数据显示，即使是本应完全免受自付费用影响的公共保险人群也受到了灾难性医疗支出的影响。在私人保险体系中，财务危机也是一个常见风险。
尽管进行了医疗改革，但财务保护仍然不足，且对贫困和弱势群体不利。需要开展更多研究，以了解为何当前机制未达到预期效果，并推动保险体系进行相应改革。
