Akazili James, McIntyre Diane, Kanmiki Edmund W, Gyapong John, Oduro Abraham, Sankoh Osman, Ataguba John E
a Navrongo Health Research Centre , Ghana Health Service , Navrongo , Ghana.
b Health Systems Working Group , INDEPTH Network , Accra , Ghana.
Glob Health Action. 2017;10(1):1289735. doi: 10.1080/16549716.2017.1289735.
Financial risk protection against the cost of unforeseen healthcare has gained global attention in recent years. Although Ghana implemented a nationwide health insurance scheme with a goal of reducing financial barriers to accessing healthcare and addressing impoverishing effects of out-of-pocket (OOP) healthcare payments, there is a paucity of knowledge on the extent of financial catastrophe of such payments in Ghana. Thus, this paper assesses the catastrophic effect of OOP healthcare payments in Ghana.
Ghana Living Standard Survey (GLSS 5) data collected in 2005/2006 are used in this study. Catastrophic effect of OOP healthcare payments is assessed using various thresholds of total household expenditure and non-food expenditure. Furthermore, four indices, namely the catastrophic payment headcount, catastrophic payment gap, weighted catastrophic payment headcount and weighted catastrophic payment gap, are defined and computed.
As at 2005/2006, it was estimated that 11.0% of households in Ghana spent over 5% of their total household expenditure on healthcare OOP. However, after adjusting for the concentration of such spending, it decreased to 10.9%. Also 10.7% of households spent more than 10% of their non-food consumption expenditure on OOP healthcare payments. Furthermore, about 2.6% of households are observed to have spent in excess of 20% of their total household income on healthcare OOP. With the exception of the 5% threshold of household expenditure, because the concentration indices of these expenditures are negative, the burden of such expenditures rests more on the poor.
Significant levels of financial catastrophe existed in Ghana prior to the uptake of the national health insurance scheme. Poorer households were at a higher risk than the relatively well-off households. The results of this study present baseline assessment of the impact of Ghana's health insurance policy on catastrophic healthcare payments. Thus, there is a need for continuous monitoring of financial catastrophe in the system to ensure that households are adequately protected.
近年来，防范不可预见医疗费用的金融风险保障已受到全球关注。尽管加纳实施了全国性医疗保险计划，目标是减少获取医疗服务的经济障碍并解决自付医疗费用的致贫影响，但对于加纳此类支付导致的经济灾难程度，人们了解甚少。因此，本文评估了加纳自付医疗费用的灾难性影响。
本研究使用了2005/2006年收集的加纳生活水平调查（GLSS 5）数据。使用家庭总支出和非食品支出的各种阈值来评估自付医疗费用的灾难性影响。此外，定义并计算了四个指数，即灾难性支付发生率、灾难性支付差距、加权灾难性支付发生率和加权灾难性支付差距。
截至2005/2006年，据估计加纳11.0%的家庭将超过5%的家庭总支出用于自付医疗费用。然而，在对这种支出的集中程度进行调整后，这一比例降至10.9%。还有10.7%的家庭将超过10%的非食品消费支出用于自付医疗费用。此外，约2.6%的家庭被观察到将超过20%的家庭总收入用于自付医疗费用。除了家庭支出的5%阈值外，由于这些支出的集中指数为负，此类支出的负担更多地落在穷人身上。
在实施国家医疗保险计划之前，加纳存在相当程度的金融灾难。较贫困家庭比相对富裕家庭面临更高风险。本研究结果提供了加纳医疗保险政策对灾难性医疗支付影响的基线评估。因此，有必要持续监测该系统中的金融灾难情况，以确保家庭得到充分保护。
