Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Health Metrics and Measurement Cluster, World Health Organization, Geneva, Switzerland.
Int J Equity Health. 2019 Jan 15;18(1):9. doi: 10.1186/s12939-018-0906-x.
Treatment of non-communicable diseases (NCDs) in low-and-middle-income countries (LMICs) is costly and could expose households to financial hardship and vulnerability. This paper examines the association between medication costs of two major NCDs - hypertension (blood pressure) and diabetes, and household-level incidences of catastrophic health expenditure (CHE) in a South Asian LMIC, Pakistan.
The study analyzes self-reported blood pressure and diabetes (BPD) medication expenditure from the latest version (2015-16) of the Household Integrated Economic Survey (HIES) of Pakistan, a nationally representative survey of 24,238 households. The incidence of CHE is defined as households' out-of-pocket (OOP) medical expenditure exceeding 10% of the total household expenditure. Using a linear probability model, we estimate the adjusted differences in CHE incidence between households that are spending and 'not' spending on BPD medication. We also analyze several hypothetical scenarios of BPD medication cost coverage, and compare the estimated CHE incidences of respective scenarios with the status quo.
We find that the average monthly medical expenditure, and average medical expenditure share are significantly higher for households spending on BPD medication, compared to households 'not' spending. The incidence of CHE is found 6.7 percentage point higher for the households consuming BPD medication, after controlling for relevant socioeconomic attributes. If 25, 50, and 100% of the BPD medication OOP cost is covered, then the CHE incidence would reduce respectively by 5.9, 12.7, and 21.4% compared to the status quo.
Medication cost for managing two major NCDs and household catastrophic health expenditure have strong associations. The findings inform policies toward ensuring access to necessary healthcare services, and protecting households from NCD treatment related financial hardship.
在中低收入国家（LMICs）治疗非传染性疾病（NCDs）成本高昂，可能使家庭面临经济困难和脆弱性。本文考察了南亚 LMIC 国家巴基斯坦两种主要 NCD（高血压（血压）和糖尿病）药物治疗费用与家庭灾难性卫生支出（CHE）发生率之间的关系。
本研究分析了巴基斯坦最新版（2015-16 年）家庭综合经济调查（HIES）中自我报告的血压和糖尿病（BPD）药物支出，这是一项针对 24238 户家庭的全国代表性调查。 CHE 的发生率定义为家庭自付医疗支出超过家庭总支出的 10%。使用线性概率模型，我们估计了在 BPD 药物支出和“不”支出之间 CHE 发生率的调整差异。我们还分析了几种 BPD 药物费用覆盖的假设情景，并将估计的 CHE 发生率与现状进行了比较。
我们发现，与不支出 BPD 药物的家庭相比，支出 BPD 药物的家庭每月医疗支出和平均医疗支出份额明显更高。控制相关社会经济属性后，发现使用 BPD 药物的家庭 CHE 发生率高出 6.7 个百分点。如果 BPD 药物自付费用的 25%、50%和 100%得到覆盖，那么与现状相比，CHE 发生率将分别降低 5.9%、12.7%和 21.4%。
管理两种主要 NCD 的药物费用与家庭灾难性卫生支出之间存在很强的关联。研究结果为确保获得必要的医疗服务以及保护家庭免受 NCD 治疗相关经济困难的政策提供了信息。
