Oyarte Marcela, Espinoza Manuel, Balmaceda Carlos, Villegas Rodrigo, Cabieses Báltica, Díaz Janepsy
Instituto de Salud Pública de Chile, Santiago, Chile; Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Departamento de Salud Pública Facultad de Medicina Pontificia, Universidad Católica de Chile, Santiago, Chile; Centre for Health Economics University of York, York, UK.
Value Health Reg Issues. 2018 Dec;17:202-209. doi: 10.1016/j.vhri.2018.09.006. Epub 2018 Nov 15.
Out-of-pocket spent (OPS) of health services are considered inefficient and are a consequence of inequalities in financing and access. The main objective of this study was to compare OPS on health and medicine, including catastrophic expenditure, overall and by quintiles and deciles, for the great Santiago city in the periods 1997, 2007 and 2012.
Cross-sectional study based on household budget surveys 1997, 2007 and 2012. OPS on health and medicine for households of the great Santiago was estimated overall and for different quintiles and deciles. In addition, the probability of incurring in catastrophic due to health and drug expenditure were also estimated.
OPS showed a progressive increase in the three periods. Drug spending showed a decrease concentrated in the lower deciles and an increase in top deciles of expenditure. Catastrophic drug expenditure decreased progressively. By observing the catastrophic drug spending by deciles were the three richest deciles which showed a large increase between 2007 and 2012.
OPS on health remained high between 2007 and 2012, despite presenting slight decreases in some quintiles and deciles. However, drug coverage improved over time. This study demonstrates that improvements are needed in the financial protection mechanisms on health in Chile, especially for poorer quintiles and deciles.
卫生服务的自付费用（OPS）被认为是低效的，并且是融资和获取方面不平等的结果。本研究的主要目的是比较1997年、2007年和2012年期间大圣地亚哥市在卫生和医疗方面的自付费用，包括灾难性支出，总体情况以及按五分位数和十分位数划分的情况。
基于1997年、2007年和2012年家庭预算调查的横断面研究。对大圣地亚哥家庭在卫生和医疗方面的自付费用进行总体估算，并按不同的五分位数和十分位数进行估算。此外，还估算了因卫生和药品支出导致灾难性支出的概率。
在这三个时期，自付费用呈逐步上升趋势。药品支出呈现出下降趋势，集中在较低的十分位数，而较高十分位数的支出则有所增加。灾难性药品支出逐渐减少。通过观察按十分位数划分的灾难性药品支出情况，发现最富有的三个十分位数在2007年至2012年期间大幅增加。
尽管在某些五分位数和十分位数中略有下降，但2007年至2012年期间卫生方面的自付费用仍然很高。然而，随着时间的推移，药品覆盖范围有所改善。本研究表明，智利的卫生财务保护机制需要改进，特别是对于较贫困的五分位数和十分位数人群。
