Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Malaria Alert Center, Malawi College of Medicine, Blantyre, Malawi.
Malar J. 2017 Oct 2;16(1):395. doi: 10.1186/s12936-017-2038-y.
With 71% of Malawians living on < $1.90 a day, high household costs associated with severe malaria are likely a major economic burden for low income families and may constitute an important barrier to care seeking. Nevertheless, few efforts have been made to examine these costs. This paper describes household costs associated with seeking and receiving inpatient care for malaria in health facilities in Malawi.
A cross-sectional survey was conducted in a representative nationwide sample of 36 health facilities providing inpatient treatment for malaria from June-August, 2012. Patients admitted at least 12 h before study team visits who had been prescribed an antimalarial after admission were eligible to provide cost information for their malaria episode, including care seeking at previous health facilities. An ingredients-based approach was used to estimate direct costs. Indirect costs were estimated using a human capital approach. Key drivers of total household costs for illness episodes resulting in malaria admission were assessed by fitting a generalized linear model, accounting for clustering at the health facility level.
Out of 100 patients who met the eligibility criteria, 80 (80%) provided cost information for their entire illness episode to date and were included: 39% of patients were under 5 years old and 75% had sought care for the malaria episode at other facilities prior to coming to the current facility. Total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively. Facility management type, household distance from the health facility, patient age, high household wealth, and duration of hospital stay were all significant drivers of overall costs.
Although malaria treatment is supposed to be free in public health facilities, households in Malawi still incur high direct and indirect costs for malaria illness episodes that result in hospital admission. Finding ways to minimize the economic burden of inpatient malaria care is crucial to protect households from potentially catastrophic health expenditures.
马拉维 71%的人口每天生活费不足 1.90 美元，因此，高额的家庭医疗费用可能是低收入家庭的主要经济负担，也可能成为寻求治疗的重要障碍。然而，很少有研究关注这些费用。本文描述了马拉维卫生机构治疗疟疾的住院费用，包括寻求和接受住院治疗的家庭费用。
2012 年 6 月至 8 月，在马拉维全国范围内有代表性的 36 个提供疟疾住院治疗的卫生机构进行了横断面调查。符合以下条件的患者可提供疟疾发病的费用信息，包括在之前卫生机构的就诊情况：在研究团队访问前至少 12 小时入院，入院后开了抗疟药。采用基于成分的方法估算直接费用，采用人力资本法估算间接费用。使用广义线性模型评估导致疟疾住院的疾病总家庭费用的主要驱动因素，考虑卫生机构层面的聚类。
符合纳入标准的 100 名患者中，80 名（80%）提供了截至目前整个发病过程的费用信息，包括：39%的患者年龄在 5 岁以下，75%的患者在来当前医院之前曾在其他机构就诊。家庭总费用平均为每位患者 17.48 美元；直接和间接家庭费用分别为 7.59 美元和 9.90 美元。机构管理类型、家庭与卫生机构的距离、患者年龄、高家庭财富和住院时间长短均为总费用的重要驱动因素。
尽管公共卫生机构的疟疾治疗应该是免费的，但马拉维家庭仍因导致住院的疟疾发病而产生高昂的直接和间接费用。寻找减少住院疟疾治疗经济负担的方法对于保护家庭免受潜在灾难性医疗支出至关重要。
