Nakovics Meike Irene, Brenner Stephan, Bongololo Grace, Chinkhumba Jobiba, Kalmus Olivier, Leppert Gerald, De Allegri Manuela
Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany.
Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi.
Health Econ Rev. 2020 May 27;10(1):14. doi: 10.1186/s13561-020-00271-2.
Monitoring financial protection is a key component in achieving Universal Health Coverage, even for health systems that grant their citizens access to care free-of-charge. Our study investigated out-of-pocket expenditure (OOPE) on curative healthcare services and their determinants in rural Malawi, a country that has consistently aimed at providing free healthcare services.
Our study used data from two consecutive rounds of a household survey conducted in 2012 and 2013 among 1639 households in three districts in rural Malawi. Given our explicit focus on OOPE for curative healthcare services, we relied on a Heckman selection model to account for the fact that relevant OOPE could only be observed for those who had sought care in the first place.
Our sample included a total of 2740 illness episodes. Among the 1884 (68.75%) that had made use of curative healthcare services, 494 (26.22%) had incurred a positive healthcare expenditure, whose mean amounted to 678.45 MWK (equivalent to 2.72 USD). Our analysis revealed a significant positive association between the magnitude of OOPE and age 15-39 years (p = 0.022), household head (p = 0.037), suffering from a chronic illness (p = 0.019), illness duration (p = 0.014), hospitalization (p = 0.002), number of accompanying persons (p = 0.019), wealth quartiles (p = 0.018; p = 0.001; p = 0.002), and urban residency (p = 0.001).
Our findings indicate that a formal policy commitment to providing free healthcare services is not sufficient to guarantee widespread financial protection and that additional measures are needed to protect particularly vulnerable population groups.
监测财务保护是实现全民健康覆盖的关键组成部分，即使对于那些让公民能够免费获得医疗服务的卫生系统来说也是如此。我们的研究调查了马拉维农村地区治疗性医疗服务的自付费用（OOPE）及其决定因素，马拉维一直致力于提供免费医疗服务。
我们的研究使用了2012年和2013年在马拉维农村三个地区对1639户家庭进行的两轮连续家庭调查的数据。鉴于我们明确关注治疗性医疗服务的自付费用，我们依靠赫克曼选择模型来解释这样一个事实，即只有那些首先寻求医疗服务的人才能观察到相关的自付费用。
我们的样本总共包括2740次疾病发作。在使用过治疗性医疗服务的1884人（68.75%）中，有494人（26.22%）产生了正向医疗支出，平均支出为678.45马拉维克瓦查（相当于2.72美元）。我们的分析显示，自付费用的数额与15至39岁的年龄（p = 0.022）、户主（p = 0.037）、患有慢性病（p = 0.019）、疾病持续时间（p = 0.014）、住院治疗（p = 0.002）、陪同人数（p = 0.019）、财富四分位数（p = 0.018；p = 0.001；p = 0.002）以及城市居住情况（p = 0.001）之间存在显著的正相关。
我们的研究结果表明，提供免费医疗服务的正式政策承诺不足以保证广泛的财务保护，需要采取额外措施来保护特别脆弱的人群。
