School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O. Box 1436, Hawassa, Ethiopia.
Centre for International Health, University of Bergen, Bergen, Norway.
Int J Equity Health. 2020 May 18;19(1):69. doi: 10.1186/s12939-020-01183-7.
Ethiopian households' out-of-pocket healthcare payments constitute one-third of the national healthcare budget and are higher than the global and low-income countries average, and even the global target. Such out-of-pocket payments pose severe financial risks, can be catastrophic, impoverishing, and one of the causal barriers for low utilisation of healthcare services in Ethiopia. This study aimed to assess the financial risk of seeking maternal and neonatal healthcare in southern Ethiopia.
A population-based cohort study was conducted among 794 pregnant women, 784 postpartum women, and their 772 neonates from 794 households in rural kebeles of the Wonago district, southern Ethiopia. The financial risk was estimated using the incidence of catastrophic healthcare expenditure, impoverishment, and depth of poverty. Annual catastrophic healthcare expenditure was determined if out-of-pocket payments exceeding 10% of total household or 40% of non-food expenditure. Impoverishment was analysed based on total household expenditure and the international poverty line of ≈ $1.9 per capita per day.
Approximately 93% (735) of pregnant women, 31% (244) of postpartum women, and 48% (369) of their neonates experienced illness. However, only 56 households utilised healthcare services. The median total household expenditure was $527 per year (IQR = 390: 370,760). The median out-of-pocket healthcare payment was $46 per year (IQR = 46: 46, 92) with two episodes per household, and shared 19% of the household's budget. The poorer households paid more than did the richer for healthcare, during pregnancy-related and neonatal illness. However, the richer paid more than did the poorer during postpartum illness. Forty-six percent of households faced catastrophic healthcare expenditure at the threshold of 10% of total household expenditure, or 74% at a 40% non-food expenditure, and associated with neonatal illness (aRR: 2.56, 95%CI: 1.02, 6.44). Moreover, 92% of households were pushed further into extreme poverty and the poverty gap among households was 45 Ethiopian Birr per day. The average household size among study households was 4.7 persons per household.
This study demonstrated that health inequity in the household's budget share of total OOP healthcare payments in southern Ethiopia was high. Besides, utilisation of maternal and neonatal healthcare services is very low and seeking such healthcare poses a substantial financial risk during illness among rural households. Therefore, the issue of health inequity should be considered when setting priorities to address the lack of fairness in maternal and neonatal health.
埃塞俄比亚家庭的医疗保健自付费用占国家医疗保健预算的三分之一，高于全球和低收入国家的平均水平，甚至高于全球目标。这种自付费用带来了严重的财务风险，可能是灾难性的，使家庭贫困，并成为埃塞俄比亚低水平利用医疗服务的一个因果障碍。本研究旨在评估埃塞俄比亚南部产妇和新生儿医疗保健的财务风险。
这是一项基于人群的队列研究，在埃塞俄比亚南部沃纳戈区的 794 个农村村落的 794 户家庭中，对 794 名孕妇、784 名产后妇女及其 772 名新生儿进行了调查。利用灾难性医疗支出、贫困和贫困深度的发生率来评估财务风险。如果自付费用超过家庭总收入的 10%或非食品支出的 40%，则确定年度灾难性医疗支出。根据家庭总支出和国际贫困线（约 1.9 美元/人/天）分析贫困状况。
约有 93%（735 名）的孕妇、31%（244 名）的产后妇女和 48%（369 名）的新生儿经历了疾病。然而，只有 56 户家庭利用了医疗服务。家庭总支出中位数为每年 527 美元（IQR=390:370，760）。家庭总支出中位数为每年 46 美元（IQR=46:46，92），每户两次，占家庭预算的 19%。在与妊娠相关的疾病和新生儿疾病期间，较贫穷的家庭比较富裕的家庭支付更多的医疗费用。然而，在产后疾病期间，较富裕的家庭比较贫穷的家庭支付更多的医疗费用。46%的家庭面临着医疗支出达到家庭总支出的 10%的门槛，或者在非食品支出达到 40%时，面临着 74%的医疗支出，这与新生儿疾病有关（aRR：2.56，95%CI：1.02，6.44）。此外，92%的家庭陷入极度贫困，家庭之间的贫困差距为每天 45 埃塞俄比亚比尔。研究家庭的平均家庭规模为每户 4.7 人。
本研究表明，埃塞俄比亚南部家庭在总自付医疗保健支出中用于医疗保健的预算份额存在很大的健康不平等。此外，产妇和新生儿医疗保健服务的利用率非常低，农村家庭在患病期间寻求此类医疗保健服务会带来巨大的财务风险。因此，在确定解决母婴健康不公平问题的优先事项时，应考虑健康不平等问题。
