Le Lan My, Flores Gabriela, Edejer Tessa Tan-Torres, Tran Toan Khanh, Nguyen Chuc Thi Kim, Tran Do Thanh, Ho Phuc Dang, Agorinya Isaiah Awintuen, Tediosi Fabrizio, Ross Amanda
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
PLoS One. 2020 Nov 25;15(11):e0242734. doi: 10.1371/journal.pone.0242734. eCollection 2020.
Out-of-pocket payments (OOPs), direct payments by households or individuals for healthcare are part of the health financing landscape. Data on OOPs is needed to monitor progress in financial risk protection, and the evaluation of health financing policies. In low-and-middle-income countries, estimates of OOPs rely heavily on self-reported data from household surveys. These surveys require respondents to recall events in the past and can suffer from recall biases. This study investigates the effect of recall period on the agreement of the amount and timing of inpatient OOPs between household reports and provider records in Bavi, Vietnam. We recruited 1397 households for interview using records from the district hospital. The households were interviewed with identical questionnaires except that the recall period was either 12 or 6 months. We linked household with provider data and excluded medicine costs from both household and provider OOPs since they could be purchased outside the hospital. We estimated the effect of recall period on the overall mean and variability of ratios of household to hospital reported OOPs using the Bland-Altman approach for method comparison. We estimated the effect of recall period on whether a transaction was recalled correctly in expenditure and time using multinomial regression. The households reported higher amounts of OOPs than did the hospital for both recall periods. There was no evidence of an effect of recall period on the mean of the ratios of household- to hospital-reported OOPs, although the confidence intervals are not inconsistent with previous studies indicating higher OOPs for shorter recall periods. The geometric mean ratio for the 6-month period was estimated to be a multiple of 1.4 (95% CI 0.9, 2.1) times that of the 12-month period. Similarly, there was no evidence of an effect of recall period on the risk of reporting lower or higher amounts than provider OOPs. The occurrence and timing of inpatient stays generally recalled well, with 70% remembered in the correct month declining slightly over time. Respondents for the 6-month recall period had a significantly lower risk of failing to report the event (RR 0.8 (0.7, 1.0)). The results suggest the best recall period may depend on whether the purpose of a survey is for the recall of the timing of events, in which case the 6 month period may be better, or the amounts of OOPs, where there was no significant difference and the provider records are not a gold standard but the 12 month period had a tendency to be in closer agreement with the provider OOPs.
自付费用（OOPs），即家庭或个人直接支付的医疗保健费用，是卫生筹资格局的一部分。需要自付费用数据来监测财务风险保护方面的进展以及评估卫生筹资政策。在低收入和中等收入国家，自付费用的估计在很大程度上依赖于家庭调查中的自我报告数据。这些调查要求受访者回忆过去的事件，可能存在回忆偏差。本研究调查了回忆期对越南巴维地区家庭报告与医疗机构记录之间住院自付费用金额和时间一致性的影响。我们利用地区医院的记录招募了1397户家庭进行访谈。除回忆期为12个月或6个月外，对这些家庭采用相同的问卷进行访谈。我们将家庭数据与医疗机构数据进行关联，并将家庭和医疗机构自付费用中的药品费用排除在外，因为药品可以在医院外购买。我们使用Bland-Altman方法进行方法比较，估计回忆期对家庭报告与医院报告的自付费用比率总体均值和变异性的影响。我们使用多项回归估计回忆期对支出和时间方面交易是否被正确回忆的影响。在两个回忆期内，家庭报告的自付费用金额均高于医院报告的金额。没有证据表明回忆期对家庭报告与医院报告的自付费用比率均值有影响，尽管置信区间与先前表明回忆期较短时自付费用较高的研究并不矛盾。估计6个月期的几何平均比率是12个月期的1.4倍（95%可信区间为0.9, 2.1）。同样，没有证据表明回忆期对报告低于或高于医疗机构自付费用金额的风险有影响。住院时间的发生和时间一般回忆得较好，70%能在正确的月份被回忆起来，且随时间略有下降。回忆期为6个月的受访者未能报告该事件的风险显著较低（相对风险0.8（0.7, 1.0））。结果表明，最佳回忆期可能取决于调查目的是回忆事件发生时间（在这种情况下6个月期可能更好）还是自付费用金额（在这种情况下没有显著差异，且医疗机构记录并非金标准，但12个月期与医疗机构自付费用的一致性倾向更高）。
