a Schneider Institutes for Health Policy, The Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA.
b Health, Nutrition and Population Global Practice , The World Bank , Washington , DC , USA.
Health Syst Reform. 2018;4(4):300-312. doi: 10.1080/23288604.2018.1513264. Epub 2018 Nov 6.
In the last decade, Zimbabwe has undertaken substantial changes and implemented new initiatives to improve health system performance and services delivery, including results-based financing in rural health facilities. This study aims to examine the utilization of health services and level of financial risk protection of Zimbabwe's health system. Using a multistage sampling approach, 7,135 households with a total of 32,294 individuals were surveyed in early 2016 on utilization of health services, out-of-pocket (OOP) health expenditure, and household consumption (as a measure of living standards) in 2015. The study found that the outpatient visits were favorable to the poor but the poorest had less access to inpatient care. In 2015, household OOP expenditure accounted for about one quarter of total health expenditure in Zimbabwe and 7.6% of households incurred catastrophic health expenditure (CHE). The incidence of CHE was 13.4% in the poorest quintile in comparison with 2.8% in the richest. Additionally, 1.29% of households fell into poverty due to health care-related expenditures. The study suggests that there are inequalities in utilization of health services among different population groups. The poor seeking inpatient care are the most vulnerable to CHE.
在过去的十年中，津巴布韦已经进行了重大变革，并实施了新的举措，以提高卫生系统的绩效和服务提供水平，包括在农村卫生机构实行基于成果的融资。本研究旨在考察津巴布韦卫生系统的卫生服务利用情况和财务风险保护水平。本研究采用多阶段抽样方法，于 2016 年初对 7135 户家庭进行了调查，共涉及 32294 人，调查内容包括 2015 年的卫生服务利用情况、自付医疗支出和家庭消费（作为生活水平的衡量标准）。研究发现，门诊就诊对穷人有利，但最贫困的人获得住院治疗的机会较少。2015 年，家庭自付医疗支出约占津巴布韦卫生总支出的四分之一，7.6%的家庭发生灾难性医疗支出（CHE）。在最贫困的五分之一家庭中，CHE 的发生率为 13.4%，而最富裕的五分之一家庭中，CHE 的发生率为 2.8%。此外，由于医疗保健相关支出，有 1.29%的家庭陷入贫困。研究表明，不同人群群体之间的卫生服务利用存在不平等现象。寻求住院治疗的穷人最容易受到 CHE 的影响。
