Gupta Indrani, Chowdhury Samik
Institute of Economic Growth, Delhi, India.
WHO South East Asia J Public Health. 2014 Jul-Dec;3(3):238-246. doi: 10.4103/2224-3151.206746.
A key objective of universal health coverage is to address inequities in the financial implications of health care. This paper examines the level and trend in out-of-pocket spending (OOPS) on health, and the consequent burden on Nepalese households.
Using data from the Nepal Living Standard Survey for 1995-1996 and 2010-2011, the paper looks at the inequity of this burden and its changes over time; across ecological zones or belts, development regions, places of residence, or consumption expenditure quintiles; and according to the gender of the head of the household.
The average per capita OOPS on health in Nepal increased sevenfold in nominal terms between 1995-1996 and 2010-2011. The share of OOPS in household consumption expenditure also increased during the same period, primarily as a result of higher health spending by poorer households. Thirteen per cent of all households were found to incur catastrophic health expenses in 2010-2011. This proportion of households incurring such expenditure rose between the two time periods most sharply in the Terai belt, eastern region and poorest quintile.
The health-financing system in Nepal has become regressive over the years, as the share of the bottom two quintiles in the total number of households facing catastrophic burden increased by 14% between the two periods.
全民健康覆盖的一个关键目标是解决医疗保健财务影响方面的不公平问题。本文研究了尼泊尔家庭自付医疗费用的水平和趋势，以及由此产生的负担。
利用1995 - 1996年和2010 - 2011年尼泊尔生活水平调查的数据，本文考察了这种负担的不公平性及其随时间的变化；按生态区或地带、发展地区、居住地点或消费支出五分位数划分；以及根据户主的性别划分。
1995 - 1996年至2010 - 2011年期间，尼泊尔人均自付医疗费用名义上增长了七倍。同一时期，自付费用在家庭消费支出中的份额也有所增加，主要是因为较贫困家庭的医疗支出增加。2010 - 2011年，发现13%的家庭承担了灾难性医疗费用。在这两个时间段之间，发生此类支出的家庭比例在特莱地区、东部地区和最贫困五分位数中上升最为明显。
多年来，尼泊尔的卫生筹资系统变得具有累退性，因为在面临灾难性负担的家庭总数中，最底层两个五分位数的份额在这两个时期之间增加了14%。
