Department of Economics, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
PLoS One. 2019 Apr 10;14(4):e0214750. doi: 10.1371/journal.pone.0214750. eCollection 2019.
Despite the removal of user fees on public primary healthcare in Zambia, prior studies suggest that out-of-pocket payments are still significant. However, we have little understanding of the extent to which out-of-pocket payments lead patients to hardship methods of financing out-of-pocket costs. This study analyses the prevalence and determinants of hardship financing arising from out-of-pocket payments in healthcare, using data from a nationally-representative household health expenditure survey conducted in 2014. We employ a sequential logistic regression model to examine the factors associated with the risk of hardship financing conditional on reporting an illness and an out-of-pocket expenditure. The results show that up to 11% of households who reported an illness had borrowed money, or sold items or asked a friend for help, or displaced other household consumption in order to pay for health care. The risk of hardship financing was higher among the poorest households, female headed-households and households who reside further from health facilities. Improvements in physical access and quality of public health services have the potential to reduce the incidence of hardship financing especially among the poorest.
尽管赞比亚已经取消了公立初级医疗保健的用户费用，但之前的研究表明，自付费用仍然很重要。然而，我们对自付费用导致患者陷入困境的自费融资方式的程度了解甚少。本研究使用 2014 年进行的一项全国代表性家庭健康支出调查的数据，分析了医疗保健中自付费用导致的困境融资的流行程度和决定因素。我们采用顺序逻辑回归模型，根据报告的疾病和自付支出情况，检验与困境融资风险相关的因素。结果表明，多达 11%的报告患病的家庭为支付医疗费用而借钱、出售物品或寻求朋友帮助、或挪用其他家庭消费。最贫困家庭、女性户主家庭和居住在离医疗机构较远地区的家庭，面临困境融资的风险更高。改善物质准入和公共卫生服务质量有可能降低困境融资的发生率，尤其是在最贫困家庭中。
