National Center for Public Health, Ministry of Health, Ulaanbaatar, Mongolia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Trop Med Int Health. 2019 Jun;24(6):715-726. doi: 10.1111/tmi.13231. Epub 2019 Apr 1.
To analyse the impact of non-communicable diseases (NCDs) on household out-of-pocket (OOP) expenses, catastrophic health payments and medical impoverishment in Mongolia, a middle-income country with a high population health insurance coverage rate.
Secondary data analysis of the Mongolian Household Socioeconomic Survey with 12 840 households, including information on standard of living, OOP spending, and health conditions of household members. Measures of catastrophic spending and medical impoverishment were constructed for Mongolia. The association of medical impoverishment and catastrophic spending with a range of socioeconomic and demographic covariates and health conditions was assessed using multiple regression models.
OOP health spending contributed to an 8% increase in the incidence of poverty in Mongolia. The impoverishment associated with medical expenses is concentrated in the poorer quintiles, indicating some deepening of poverty among the already poor. Households with a member affected by NCDs and with multiple morbidities were more likely to experience catastrophic spending and medical impoverishment than those with infectious diseases. The main drivers of the financial distress were expenditures incurred for outpatient services, including for diagnostics and drugs.
Despite high rates of population health insurance coverage, health expenditures have substantial impoverishing effects in Mongolia, with the impacts being greater among households containing individuals with chronic conditions. Addressing the goal of universal health coverage (UHC) in Mongolia needs attention to the depth of coverage, especially for expenditures on outpatient care and medicines, and targeting the poor effectively.
分析在蒙古这样一个高人口医疗保险覆盖率的中等收入国家，非传染性疾病（NCDs）对家庭自付（OOP）支出、灾难性卫生支出和医疗贫困的影响。
利用蒙古家庭社会经济调查的二次数据分析，该调查包括 12840 户家庭的生活水平、OOP 支出和家庭成员健康状况信息。为蒙古构建了灾难性支出和医疗贫困的衡量标准。使用多元回归模型评估医疗贫困和灾难性支出与一系列社会经济和人口统计学协变量以及健康状况之间的关联。
OOP 健康支出导致蒙古贫困发生率增加了 8%。与医疗费用相关的贫困主要集中在较贫穷的五分位数，表明已经贫困的人群中贫困程度有所加深。患有 NCD 且患有多种疾病的家庭比患有传染病的家庭更有可能经历灾难性支出和医疗贫困。导致财务困境的主要因素是门诊服务支出，包括诊断和药物支出。
尽管蒙古的人口医疗保险覆盖率很高，但卫生支出对蒙古造成了实质性的贫困影响，对患有慢性病的家庭的影响更大。要实现蒙古的全民健康覆盖（UHC）目标，需要关注覆盖范围的深度，特别是门诊护理和药品支出，并有效地针对贫困人口。
