Verguet Stéphane, Woldemariam Addis Tamire, Durrett Warren N, Norheim Ole F, Kruk Margaret E
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Federal Democratic Republic of Ethiopia, Ministry of Health, Addis Ababa, Ethiopia.
BMJ Glob Health. 2017 Sep 28;2(3):e000216. doi: 10.1136/bmjgh-2016-000216. eCollection 2017.
Setting Millennium Development Goals and Sustainable Development Goals for health has largely focused on defining specific targets of mortality and morbidity reduction over given time periods. Yet, less attention has been devoted to setting targets for the systemic determinants of health delivery, such as access and financial risk protection (FRP)-prevention of medical impoverishment. We examined candidate targets for FRP among low and middle-income countries by 2040.
We used a data set on estimates of incidence of catastrophic health expenditure (CHE)-medical expenditure exceeding 40% of household capacity to pay-among 110 countries over 1995-2007, augmented by estimates of the percentage of out-of-pocket expenditure out of total health expenditure (OOP), the share of health expenditure as a percentage of gross domestic product (HEX) and the gross domestic product per capita (GDP). Using a simple model and 2040 estimates for OOP, HEX and GDP from the World Bank, the International Monetary Fund and the Institute for Health Metrics and Evaluation, we projected CHE incidence by 2040 for four country income groups.
We predicted that the 2040 incidence of CHE among households would be: 2.13% (Uncertainty interval: 0.60-6.87) among low-income countries, 1.15% (0.32-3.81) among lower-middle-income countries and 0.65% (0.18-2.21) among upper-middle-income countries. By 2040, the probability of achieving CHE <1.00% would be: 0.1 for low-income countries, 0.4 for lower-middle-income countries and 0.7 for upper-middle-income countries; for CHE <0.50%, it would be 0 for low-income countries, 0.1 for lower-middle-income countries and 0.3 for upper-middle-income countries.
Historical trends of CHE rates can help define post-2015 targets for FRP. The projected achievements suggest that elimination of medical impoverishment will not be achieved by 2040 and that countries must urgently enact dramatic changes in policy to ensure FRP to their populations.
制定卫生领域的千年发展目标和可持续发展目标在很大程度上侧重于确定特定时间段内降低死亡率和发病率的具体目标。然而，对于卫生服务提供的系统性决定因素设定目标的关注较少，例如医疗服务可及性和经济风险保护（FRP）——预防医疗致贫。我们研究了到2040年低收入和中等收入国家FRP的候选目标。
我们使用了一个数据集，该数据集包含1995 - 2007年期间110个国家灾难性卫生支出（CHE）——医疗支出超过家庭支付能力的40%——发生率的估计值，并补充了自费支出占卫生总支出的百分比（OOP）、卫生支出占国内生产总值的百分比（HEX）以及人均国内生产总值（GDP）的估计值。利用一个简单模型以及世界银行、国际货币基金组织和健康指标与评估研究所对2040年OOP、HEX和GDP的估计值，我们预测了四个国家收入组到2040年的CHE发生率。
我们预测，2040年家庭中CHE的发生率将为：低收入国家为2.13%（不确定区间：0.60 - 6.87），中低收入国家为1.15%（0.32 - 3.81），中高收入国家为0.65%（0.18 - 2.21）。到2040年，实现CHE < 1.00%的概率将为：低收入国家为0.1，中低收入国家为0.4，中高收入国家为0.7；对于CHE < 0.50%，低收入国家为0，中低收入国家为0.1，中高收入国家为0.3。
CHE发生率的历史趋势有助于确定2015年后FRP的目标。预测结果表明，到2040年无法消除医疗致贫现象，各国必须紧急实施重大政策变革，以确保为其民众提供经济风险保护。
