自付医疗支出对家庭贫困的影响：来自摩洛哥的证据。

The impact of out-of-pocket health expenditure on household impoverishment: Evidence from Morocco.

机构信息

Research Laboratory of Modeling Applied to Economics and Management, Hassan II University, Casablanca, Morocco.

Research Laboratory of Modeling Applied to Economics and Management, Morocco's High Commission for Planning, Casablanca, Morocco.

出版信息

Int J Health Plann Manage. 2019 Oct;34(4):e1569-e1585. doi: 10.1002/hpm.2848. Epub 2019 Jul 22.

DOI:10.1002/hpm.2848

PMID:31332829

Abstract

Health financing in Morocco relies mainly on out-of-pocket (OoP) payments. World Health Organization (WHO) has shown that these payments can expose households to catastrophic health expenditure (hereinafter CHE) and impoverish them. The study examines the financial burden of OoP health payments on Moroccan households. Two approaches-that developed by Wagstaff and Doeslear and the one advocated by WHO-are adopted to estimate the extent of CHE. These show that 1.77% of households incurred CHE at the 40% threshold for nonfood expenditure. At the 10% threshold for total consumption expenditure, 12.8% of households incurred CHE. We find that these OoP payments have made 1.11% of Moroccan households poorer. In analyzing the determinants of CHE, we estimated an ordered probit model. It appears that any of (a) hospitalization, (b) presence of an elderly person in the household, or (c) the level of poverty increases significantly the likelihood of health expenditure becoming catastrophic. On the other hand, we find that coverage by health insurance protects against CHE.

摘要

摩洛哥的卫生融资主要依赖自费（OoP）支付。世界卫生组织（WHO）已经表明，这些支付方式可能使家庭面临灾难性的医疗支出（以下简称 CHE）并使他们陷入贫困。本研究考察了 OoP 卫生支付对摩洛哥家庭的经济负担。采用了两种方法——Wagstaff 和 Doeslear 开发的方法和世卫组织倡导的方法——来估计 CHE 的程度。结果表明，40%的非食品支出阈值下，有 1.77%的家庭发生了 CHE。在总消费支出的 10%阈值下，有 12.8%的家庭发生了 CHE。我们发现，这些自费支付使 1.11%的摩洛哥家庭变得更加贫困。在分析 CHE 的决定因素时，我们估计了一个有序概率模型。结果表明，（a）住院、（b）家庭中有老年人或（c）贫困程度的任何一个因素都显著增加了医疗支出成为灾难性的可能性。另一方面，我们发现医疗保险的覆盖可以预防 CHE。