Beaugé Yvonne, Ridde Valéry, Bonnet Emmanuel, Souleymane Sidibé, Kuunibe Naasegnibe, De Allegri Manuela
Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 365, 69120, Heidelberg, Germany.
IRD (French Institute For Research on sustainable Development), CEPED (IRD-Université de Paris), ERL INSERM SAGESUD, Paris, France.
Health Econ Rev. 2020 Nov 14;10(1):36. doi: 10.1186/s13561-020-00293-w.
Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge.
We performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure.
Exemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = - 2.072, p = 0.00, ME = - 0.324; p = 0.000) and having an exemption card (β = - 1.787, p = 0.025; ME = - 0.279, p = 0.014).
User fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor's elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection.
在全民健康覆盖框架内，衡量为最贫困人口提供金融风险保护的进展情况至关重要。本研究评估了布基纳法索基于绩效的融资干预背景下被定为目标并获得豁免的极端贫困人口的自付费用水平以及与高额自付费用相关的因素。极端贫困人口是通过基于社区的方法选定的，并获得了一张豁免卡，使他们能够免费获得医疗服务。
我们使用在迪博古区进行的一项横断面研究的数据，对正规医疗服务的自付费用水平进行了描述性分析。进行多变量逻辑回归以调查极端贫困人口中与高额自付费用相关的因素。分析仅限于在过去六个月内报告因患病而使用正规医疗服务的个人。高额支出被定义为支出大于或等于自付费用中位数的两倍。
83.64%的受访者报告拥有豁免卡。极端贫困人口平均需要自付23051.62非洲法郎（39.18美元），才能在本应免费的公共卫生设施获得正规医疗服务。产生高额自付费用的可能性与女性身份（β = -2.072，p = 0.00，ME = -0.324；p = 0.000）和拥有豁免卡（β = -1.787，p = 0.025；ME = -0.279，p = 0.014）呈负相关。
免除使用费与降低极端贫困人口的自付费用相关。我们的结果表明了免费医疗以及更好地实施现有豁免政策的重要性。在分配资源以更好地解决现有不平等问题并改善金融风险保护时，需要考虑极端贫困人口因多种疾病和疾病严重程度而面临的更高风险。
