在没有用户付费的情况下，自费支付对财务风险保护指标的影响：以毛里求斯为例。
Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius.
机构信息
World Health Organization Country Office, Port Louis, Mauritius.
Statistics Mauritius, Port Louis, Mauritius.
出版信息
Int J Equity Health. 2019 May 3;18(1):63. doi: 10.1186/s12939-019-0959-5.
BACKGROUND
Mauritius embraces principles of a welfare state with free health care at point of use in any public facilities. However, the health financing landscape changed in 2007 when Private Health Expenditure (PvtHE) surpassed General Government Health Expenditure. PvtHE is predominately out of pocket (OOP) with only 3.4% related to premiums for private insurance. In 2014, Household OOP Expenditure on health accounted for 52.8% of total health expenditure. OOP is known to be regressive and to impact negatively on households' living standards.
OBJECTIVES
This paper aims to examine trends in OOP in Mauritius, to assess its impacts through an analysis of key indicators of financial protection, namely catastrophic health expenditure (CHE) and impoverishment due to OOP health expenditure. It also aims to predict core determinants of CHEs.
METHODS
Household Budget Surveys (HBS) of 2001/2002, 2006/2007 and 2012 were the primary source data. CHE and impoverishment were used to assess financial hardships resulting from OOP health payments. The incidence of CHE was estimated at three threshold levels (10,25 and 40%), using the budget share and the capacity to pay approaches. Impoverishment due to OOP was measured by changes in the incidence of poverty and intensity of poverty using the US$ 3.1 international poverty line. Logistic regression analysis was used to identify determinants of CHE.
FINDINGS
Household CHE increased from 5.78% in 2001/02 to 8.85% in 2012 and 0.61% in 2001/02 to 1.25% in 2012, for 10 and 40% thresholds, respectively. The incidence of CHE was significantly higher in urban areas compared to rural areas. The highest levels of CHEs were among households' heads, who are retired rising from 1.62% in 2001/02 to 3.71% in 2012, followed by households' head who are widowed from 2.29% in 2001/02 to 2.63% in 2012 and homemakers from 2.12% in 2001/02 to 2.57% in 2012 at the 40% threshold. The share of households pushed below the poverty line due to OOP dropped from 0.4% in 2001/02 to 0.2% in 2006/07 before rising to 0.34% in 2012. In 2012, poverty gap occurred only among households under poorest quintile 1 (0.24%) and quintile 2 (0.03%). Overall poverty gap dropped from 0.08% in 2001/02 to 0.05% in 2012. Logistic regression analysis revealed that the odds ratio of facing CHE were significant only among households with heads being retired and with a presence of an elderly member in the household.
CONCLUSION
Despite the rise in incidence of CHE between 2001 and 2012 the impact of OOP on the level of impoverishment and poverty gap has not been significant.
背景
毛里求斯信奉福利国家原则，在任何公共设施中都可享受免费医疗保健。然而，2007 年，私人医疗支出（PvtHE）超过政府卫生总支出时，毛里求斯的卫生融资状况发生了变化。PvtHE 主要是自费（OOP），只有 3.4%与私人保险的保费有关。2014 年，家庭用于健康的自费支出占总卫生支出的 52.8%。众所周知，自费是倒退的，会对家庭的生活水平产生负面影响。
目的
本文旨在研究毛里求斯自费支出的趋势，通过对财务保护的关键指标，即灾难性医疗支出（CHE）和自费医疗支出导致的贫困进行分析，评估其影响。它还旨在预测 CHE 的核心决定因素。
方法
2001/2002 年、2006/2007 年和 2012 年的家庭预算调查（HBS）是主要的原始数据来源。使用 CHE 和贫困来评估自费医疗支付带来的经济困难。使用预算份额和支付能力方法，分别在三个阈值水平（10%、25%和 40%）估计 CHE 的发生率。使用国际贫困线（3.1 美元）衡量贫困程度和贫困强度的变化来衡量因自费而导致的贫困。使用逻辑回归分析来确定 CHE 的决定因素。
结果
2001/02 年家庭 CHE 为 5.78%，2012 年增至 8.85%，2001/02 年为 0.61%，2012 年增至 1.25%，分别为 10%和 40%的阈值。城市地区 CHE 的发生率明显高于农村地区。最高水平的 CHE 是退休人员的家庭，从 2001/02 年的 1.62%上升到 2012 年的 3.71%，其次是丧偶人员的家庭，从 2001/02 年的 2.29%上升到 2012 年的 2.63%，以及家庭主妇，从 2001/02 年的 2.12%上升到 2012 年的 2.57%，在 40%的阈值下。由于自费而跌入贫困线以下的家庭比例从 2001/02 年的 0.4%降至 2006/07 年的 0.2%，然后在 2012 年上升至 0.34%。2012 年，只有最贫困的五分之一（1 分位）和五分之一（2 分位）的家庭发生贫困差距。总体贫困差距从 2001/02 年的 0.08%降至 2012 年的 0.05%。逻辑回归分析显示，只有退休人员和家中有老年人的家庭面临 CHE 的几率比重大。
结论
尽管 2001 年至 2012 年间 CHE 的发生率有所上升，但自费对贫困和贫困差距水平的影响并不显著。
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