Health Economics and Financing Research Group, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
Int J Equity Health. 2018 Apr 27;17(1):53. doi: 10.1186/s12939-018-0757-5.
Universal health coverage implies that people obtain the health services they need without experiencing financial hardship. While the factors contributing to catastrophic health expenditure (CHE) among households are well understood, few studies have examined this relationship in the context of environmentally vulnerable regions, such as tropical deltas. This study aims to examine the disparities in the prevalence of CHE and impoverishment due to out-of-pocket (OOP) healthcare payments in the Mekong Delta in comparison with rest of Vietnam. It also intends to investigate the associations between economic and environmental shocks, CHE and the impoverishment from healthcare payments.
Using data from the Vietnam Household Living Standards Survey 2012, the prevalence of CHE was estimated from the fraction of healthcare costs in relation to household consumption expenditure. The poverty headcount was estimated using the total household consumption expenditure considering both with and without OOP expenditure for healthcare in comparison with the national poverty-line. Simple and multiple logistic regression models were used to examine the associations between geography, health systems, environmental and demographic variables and OOP healthcare expenditure related CHE, and impoverishment respectively.
Both the level of OOP household healthcare expenditure and the proportion of households suffering from impoverishment as the result of such payments were higher in the Mekong Delta region compared to rest of Vietnam. Although the results from the multiple regression analysis showed that households in the Mekong Delta region were significantly less likely to suffer from CHE, they were significantly more likely to be impoverished due to OOP healthcare expenditure. While health insurance membership did not have a significant effect on either outcomes, households that faced an economic or an environmental shock in past 5 years were considerably more likely to suffer from CHE and impoverishment from OOP healthcare payments.
The findings suggest that the financial protection capacity of health insurance schemes in Vietnam should be improved and expanded to reduce impoverishment as the result of OOP healthcare payments, particularly in the Mekong Delta region. Additional investments in disaster preparedness strategies can further help to reduce the financial burden of households in this environmentally vulnerable region.
全民健康覆盖意味着人们能够获得所需的卫生服务，而不会因此陷入经济困境。虽然人们已经充分了解导致家庭灾难性卫生支出（CHE）的因素，但很少有研究在热带三角洲等环境脆弱地区的背景下研究这种关系。本研究旨在比较湄公河三角洲与越南其他地区家庭因自付医疗费用而出现 CHE 和贫困的情况，并调查经济和环境冲击、CHE 与医疗费用导致的贫困之间的关系。
本研究使用 2012 年越南家庭生活水平调查的数据，根据医疗支出占家庭消费支出的比例来估算 CHE 的患病率。使用总家庭消费支出来估计贫困人数，同时考虑有无自付医疗支出，并与国家贫困线进行比较。使用简单和多因素逻辑回归模型，分别研究地理、卫生系统、环境和人口统计学变量与自付医疗支出相关的 CHE 和贫困之间的关系。
与越南其他地区相比，湄公河三角洲地区的家庭自付医疗支出水平和因自付医疗支出而陷入贫困的家庭比例都更高。尽管多因素回归分析的结果表明，湄公河三角洲地区的家庭发生 CHE 的可能性显著降低，但由于自付医疗支出而陷入贫困的可能性却显著增加。尽管医疗保险参保并没有对这两个结果产生显著影响，但在过去 5 年内面临经济或环境冲击的家庭发生 CHE 和因自付医疗支出而导致贫困的可能性要大得多。
研究结果表明，越南的医疗保险计划应提高和扩大其财务保障能力，以减少因自付医疗支出而导致的贫困，特别是在湄公河三角洲地区。增加对备灾战略的投资可以进一步帮助减轻这个环境脆弱地区家庭的经济负担。
