Development Research Group, World Bank, Washington, DC, USA.
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.
Lancet Glob Health. 2018 Feb;6(2):e169-e179. doi: 10.1016/S2214-109X(17)30429-1. Epub 2017 Dec 13.
The goal of universal health coverage (UHC) requires inter alia that families who get needed health care do not suffer undue financial hardship as a result. This can be measured by the percentage of people in households whose out-of-pocket health expenditures are large relative to their income or consumption. We aimed to estimate the global incidence of catastrophic health spending, trends between 2000 and 2010, and associations between catastrophic health spending and macroeconomic and health system variables at the country level.
We did a retrospective observational study of health spending using data obtained from household surveys. Of 1566 potentially suitable household surveys, 553 passed quality checks, covering 133 countries between 1984 and 2015. We defined health spending as catastrophic when it exceeded 10% or 25% of household consumption. We estimated global incidence by aggregating up from every country, using a survey for the year in question when available, and interpolation and model-based estimates otherwise. We used multiple regression to explore the relation between a country's incidence of catastrophic spending and gross domestic product (GDP) per person, the Gini coefficient for income inequality, and the share of total health expenditure spent by social security funds, other government agencies, private insurance schemes, and non-profit institutions.
The global incidence of catastrophic spending at the 10% threshold was estimated as 9·7% in 2000, 11·4% in 2005, and 11·7% in 2010. Globally, 808 million people in 2010 incurred catastrophic health spending. Across 94 countries with two or more survey datapoints, the population-weighted median annual rate of change of catastrophic payment incidence was positive whatever catastrophic payment incidence measure was used. Incidence of catastrophic payments was correlated positively with GDP per person and the share of GDP spent on health, and incidence correlated negatively with the share of total health spending channelled through social security funds and other government agencies.
The proportion of the population that is supposed to be covered by health insurance schemes or by national or subnational health services is a poor indicator of financial protection. Increasing the share of GDP spent on health is not sufficient to reduce catastrophic payment incidence; rather, what is required is increasing the share of total health expenditure that is prepaid, particularly through taxes and mandatory contributions.
Rockefeller Foundation, Ministry of Health of Japan, UK Department for International Development (DFID).
全民健康覆盖的目标除其他外，要求家庭获得所需的医疗保健而不因此遭受过度的经济困难。这可以通过家庭中其自付医疗支出相对于收入或消费过高的人口百分比来衡量。我们旨在估计全球灾难性卫生支出的发生率、2000 年至 2010 年的趋势，以及国家一级灾难性卫生支出与宏观经济和卫生系统变量之间的关系。
我们使用来自家庭调查的数据进行了一项关于卫生支出的回顾性观察研究。在 1566 个可能合适的家庭调查中，有 553 个通过了质量检查，涵盖了 1984 年至 2015 年期间的 133 个国家。当卫生支出超过家庭消费的 10%或 25%时，我们将其定义为灾难性支出。我们通过从每个国家汇总数据进行全球发生率估计，使用当年的调查数据（如果有），否则使用插值和基于模型的估计。我们使用多元回归来探讨一个国家灾难性支出发生率与人均国内生产总值（GDP）、收入不平等的基尼系数以及社会保障基金、其他政府机构、私人保险计划和非营利机构在总卫生支出中所占份额之间的关系。
2000 年 10%门槛的全球灾难性支出发生率估计为 9.7%，2005 年为 11.4%，2010 年为 11.7%。2010 年，全球有 8.08 亿人发生灾难性卫生支出。在 94 个有两个或更多调查数据点的国家中，无论使用何种灾难性支出发生率衡量标准，人口加权的年度变化中位数都是正的。灾难性支付发生率与人均 GDP 和用于卫生的 GDP 份额呈正相关，与通过社会保障基金和其他政府机构分配的总卫生支出份额呈负相关。
应该由健康保险计划或国家或国家以下各级卫生服务覆盖的人口比例是衡量财务保护的一个很差的指标。增加用于卫生保健的 GDP 份额不足以降低灾难性支出发生率；相反，需要增加预付的总卫生支出份额，特别是通过税收和强制性缴款。
洛克菲勒基金会、日本厚生省、英国国际发展部（DFID）。
