CHU de Montpellier, Montpellier, France.
CEPEL, UMR 5112 CNRS Université de Montpellier, Montpellier, France.
PLoS One. 2019 May 8;14(5):e0216386. doi: 10.1371/journal.pone.0216386. eCollection 2019.
Out-of-pocket payments might threaten the vertical equity of financing and generate unmet medical needs. The main objective was to assess the vertical equity of outpatient out-of-pocket payments for lymphedema patients in France. Twenty-seven centres, among which 11 secondary care hospitals and 16 primary care practices participated in this prospective national multicenter study. We measured the lymphedema-specific outpatient out-of-pocket payments over 6 months. The vertical equity of out-of-pocket payments was examined using concentration curves, the Gini coefficient for income, the Kakwani index, and the Reynolds-Smolensky index. We included 231 lymphedema patients aged 7 years or more, living in metropolitan France, and being able to use Internet and email. After voluntary health insurance reimbursement, the mean out-of-pocket payment was equal to 101.4 Euros per month, mainly due to transport (32%) and medical devices (26%). Concentration curves indicated regressivity of out-of-pocket payments. Total out-of-pocket payments represented 10.1% of the income by consumption unit for the poorest quintile and 3.5% for the wealthiest (p<0.05). The Kakwani index for out-of-pocket payments was equal to -0.18. Regarding outpatient health care, French lymphedema patients face significant and regressive out-of-pocket payments, associated with an increased risk of unmet medical needs. Such results shed light on significant socioeconomic inequalities and bring into question the current financing arrangements of outpatient health care in France. Trial registration: ClinicalTrials.gov ID: NCT02988479.
自付费用可能会威胁到融资的纵向公平性，并产生未满足的医疗需求。主要目的是评估法国淋巴水肿患者门诊自付费用的纵向公平性。有 27 个中心参与了这项前瞻性全国多中心研究，其中 11 个为二级保健医院，16 个为初级保健诊所。我们在 6 个月内测量了特定于淋巴水肿的门诊自付费用。使用集中曲线、收入基尼系数、Kakwani 指数和 Reynolds-Smolensky 指数来检查自付费用的纵向公平性。我们纳入了 231 名年龄在 7 岁及以上、居住在法国大都市、能够使用互联网和电子邮件的淋巴水肿患者。在自愿健康保险报销后，平均每月自付费用为 101.4 欧元，主要用于交通（32%）和医疗设备（26%）。集中曲线表明自付费用呈倒退趋势。最贫穷的五分之一家庭的自付费用占消费单位收入的 10.1%，而最富裕的五分之一家庭的自付费用占 3.5%（p<0.05）。自付费用的 Kakwani 指数为-0.18。关于门诊医疗保健，法国淋巴水肿患者面临着大量的倒退性自付费用，这增加了未满足的医疗需求的风险。这些结果揭示了显著的社会经济不平等，并对法国门诊医疗保健的现行融资安排提出了质疑。试验注册：ClinicalTrials.gov 标识符：NCT02988479。
