Islam Md Rashedul, Rahman Md Shafiur, Islam Zobida, Nurs Cherri Zhang B, Sultana Papia, Rahman Md Mizanur
Department of Computer Science, Uttara Commerce College, Dhaka, Bangladesh.
Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
Int J Equity Health. 2017 Apr 4;16(1):59. doi: 10.1186/s12939-017-0556-4.
Financial risk protection and equity are major components of universal health coverage (UHC), which is defined as ensuring access to health services for all citizens without any undue financial burden. We investigated progress towards UHC financial risk indicators and assessed variability of inequalities in financial risk protection indicators by wealth quintile. We further examined the determinants of different financial hardship indicators related to healthcare costs.
A cross-sectional, three-stage probability survey was conducted in Bangladesh, which collected information from 1600 households from August to November 2011. Catastrophic health payments, impoverishment, and distress financing (borrowing or selling assets) were treated as financial hardship indicators in UHC. Poisson regression models were used to identify the determinants of catastrophic payment, impoverishment and distress financing separately. Slope, relative and concentration indices of inequalities were used to assess wealth-based inequalities in financial hardship indicators.
The study found that around 9% of households incurred catastrophic payments, 7% faced distress financing, and 6% experienced impoverishing health payments in Bangladesh. Slope index of inequality indicated that the incidence of catastrophic health payment and distress financing among the richest households were 12 and 9 percentage points lower than the poorest households respectively. Multivariable Poisson regression models revealed that all UHC financial hardship indicators were significantly higher among household that had members who received inpatient care or were in the poorest quintile. The presence of a member with chronic illness in a household increased the risk of impoverishment by nearly double.
This study identified a greater inequality in UHC financial hardship indicators. Rich households in Bangladesh were facing disproportionately less financial hardship than the poor ones. Households can be protected from financial hardship associated with healthcare costs by implementing risk pooling mechanism, increasing GDP spending on health, and properly monitoring subsidized programs in public health facilities.
财务风险保护和平等是全民健康覆盖（UHC）的主要组成部分，全民健康覆盖被定义为确保所有公民能够获得医疗服务，且不会承受任何过度的财务负担。我们调查了全民健康覆盖财务风险指标的进展情况，并评估了按财富五分位数划分的财务风险保护指标不平等的变化情况。我们还进一步研究了与医疗费用相关的不同财务困难指标的决定因素。
在孟加拉国进行了一项横断面、三阶段概率调查，于2011年8月至11月从1600户家庭收集信息。灾难性医疗支出、贫困化和应急融资（借款或出售资产）被视为全民健康覆盖中的财务困难指标。采用泊松回归模型分别确定灾难性支出、贫困化和应急融资的决定因素。不平等的斜率、相对和集中指数用于评估财务困难指标中基于财富的不平等。
研究发现，在孟加拉国，约9%的家庭发生了灾难性支出，7%面临应急融资，6%经历了致贫性医疗支出。不平等斜率指数表明，最富有家庭中灾难性医疗支出和应急融资的发生率分别比最贫困家庭低12和9个百分点。多变量泊松回归模型显示，在有成员接受住院治疗或处于最贫困五分位数的家庭中，所有全民健康覆盖财务困难指标都显著更高。家庭中存在慢性病成员会使贫困风险增加近一倍。
本研究发现全民健康覆盖财务困难指标存在更大的不平等。孟加拉国的富裕家庭面临的财务困难比贫困家庭少得多。通过实施风险共担机制、增加卫生领域的国内生产总值支出以及妥善监测公共卫生设施中的补贴项目，可以保护家庭免受与医疗费用相关的财务困难。
