社区健康保险对埃塞俄比亚东北部灾难性卫生支出的影响：一项横断面研究。
The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study.
机构信息
Department of Health Service Management and Health Economics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Health System, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
出版信息
PLoS One. 2018 Oct 18;13(10):e0205972. doi: 10.1371/journal.pone.0205972. eCollection 2018.
INTRODUCTION
Moving towards the goal of universal health coverage requires strengthening service delivery and overcoming significant financial barriers. The Government of Ethiopia is rolling out community based health insurance to protect the rural community from high out of pocket health expenditure and improve health service utilization. We investigated the effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia.
METHODS
A community based cross sectional study was conducted. A Multi stage sampling technique was used to get a total of 454 (224 insured and 230 uninsured) households. The data were entered using EPI info version 7 and analyzed using SPSS version 20 and STATA version 13 for binary logistic regression analysis and propensity score matching analysis respectively. Wealth status of the households was computed by Principal Component Analysis (PCA). A multivariable logistic regression analysis was done to identify the predictors of catastrophic health expenditure. Propensity score matching analysis was used to determine the effect of community based health insurance on catastrophic health expenditure. The average treatment effect on the treated (ATT) was calculated to compare the means of outcomes across insured and uninsured households.
RESULTS
A total of 454 household heads were included in the study, making a response rate of 91.2%.The total level of catastrophic health expenditure was found to be 20%. Among the households with catastrophic health expenditure, 4.41% were insured, whereas the remaining 15.64% were noninsured. Insured households (AOR = 0.19, 95% CI: 0.11-0.34), rich households (AOR = 1.98; 95% CI: 1.07-3.66), having member with chronic illness (AOR = 2.13, 95% CI: 1.01-4.51) and having member encountered any illness during the past 3 months (AOR = 2.44, 95% CI: 1.35-4.40) were statistically associated with catastrophic health expenditure. Community based health insurance contributed to 23.2% (t = -5.94) (95% CI: -0.31_-0.15) reduction of catastrophic health expenditure.
CONCLUSION
The overall level of catastrophic health expenditure was high among noninsured households. Community based health insurance has significant financial protection from catastrophic health expenditure in northeast Ethiopia. Thus, the government need to scale up community based health insurance to protect the noninsured households from catastrophic health expenditure.
简介
迈向全民健康覆盖的目标需要加强服务提供并克服重大的财务障碍。埃塞俄比亚政府正在推出社区医疗保险，以保护农村社区免受高额自付医疗支出的影响，并提高卫生服务的利用度。我们调查了社区医疗保险对东北埃塞俄比亚灾难性医疗支出的影响。
方法
进行了一项基于社区的横断面研究。采用多阶段抽样技术，共获得 454 户家庭（224 户参保和 230 户未参保）。数据使用 EPI info 版本 7 输入，并使用 SPSS 版本 20 和 STATA 版本 13 进行分析，分别进行二元逻辑回归分析和倾向评分匹配分析。通过主成分分析（PCA）计算家庭的财富状况。进行多变量逻辑回归分析，以确定灾难性医疗支出的预测因素。使用倾向评分匹配分析来确定社区医疗保险对灾难性医疗支出的影响。计算了治疗组的平均治疗效果（ATT），以比较参保和未参保家庭的结果均值。
结果
共有 454 户家庭户主纳入研究，应答率为 91.2%。灾难性医疗支出的总水平为 20%。在发生灾难性医疗支出的家庭中，有 4.41%的家庭参保，而其余 15.64%的家庭未参保。参保家庭（AOR = 0.19，95%CI：0.11-0.34）、富裕家庭（AOR = 1.98；95%CI：1.07-3.66）、有慢性病患者的家庭（AOR = 2.13，95%CI：1.01-4.51）和在过去 3 个月中遇到任何疾病的成员的家庭（AOR = 2.44，95%CI：1.35-4.40）与灾难性医疗支出有统计学关联。社区医疗保险对灾难性医疗支出的贡献为 23.2%（t = -5.94）（95%CI：-0.31_-0.15）。
结论
未参保家庭的灾难性医疗支出总体水平较高。社区医疗保险对东北埃塞俄比亚的灾难性医疗支出具有显著的财务保护作用。因此，政府需要扩大社区医疗保险的覆盖范围，以保护非参保家庭免受灾难性医疗支出的影响。
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