Guinness Lorna, Paul Repon C, Martins Joao S, Asante Auguste, Price Jennifer A, Hayen Andrew, Jan Stephen, Soares Ana, Wiseman Virginia
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK.
School of Public Health and Community Medicine, University of New South Wales, Samuels Building, Kensington, NSW, Australia.
Int Health. 2018 Nov 1;10(6):412-420. doi: 10.1093/inthealth/ihy044.
Health financing and delivery reforms designed to achieve universal health coverage (UHC) need to be informed by an understanding of factors that both promote access to health care and undermine it. This study examines the level of health care utilisation in Timor-Leste and the factors that drive it.
Data from a nationally representative cross-sectional survey of health care utilisation in 1712 households were used to develop multilevel models exploring how need and predisposing and enabling factors explain health care utilisation at both primary and secondary care facilities.
Need was found to be the key driver in seeking both primary care and hospital services. Rural households were less likely to go to hospital (odds ratio 0.7) than urban households. The poorest quintile was also less likely to use more expensive hospital services than other socio-economic groups.
Understanding the determinants of seeking health care in Timor-Leste is of considerable policy significance, because health care is free at the point of use. Our findings indicate that the public resources for health care are subsidising the rich more than the poor. Health care reforms in Timor-Leste need to reduce the 'other' costs of health care, such as distance barriers, to address these inequities.
旨在实现全民健康覆盖（UHC）的卫生筹资与服务提供改革，需要在了解促进和阻碍获得医疗服务的因素的基础上进行。本研究考察了东帝汶的医疗服务利用水平及其驱动因素。
利用对1712户家庭进行的具有全国代表性的医疗服务利用横断面调查数据，建立多层次模型，探讨需求、 predisposing因素和促成因素如何解释初级和二级医疗机构的医疗服务利用情况。
发现需求是寻求初级保健和医院服务的关键驱动因素。农村家庭去医院的可能性低于城市家庭（比值比为0.7）。最贫困的五分之一人口比其他社会经济群体使用更昂贵医院服务的可能性也更低。
了解东帝汶寻求医疗服务的决定因素具有重要的政策意义，因为医疗服务在使用时是免费的。我们的研究结果表明，医疗保健的公共资源对富人的补贴比对穷人的补贴更多。东帝汶的医疗改革需要降低医疗保健的“其他”成本，如距离障碍，以解决这些不平等问题。
