Shikuro Debelo, Yitayal Mezgebu, Kebede Adane, Debie Ayal
Benshangul-Gumuz National Regional State Health Bureau, Assossa, Ethiopia.
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Clinicoecon Outcomes Res. 2020 Dec 31;12:761-769. doi: 10.2147/CEOR.S285715. eCollection 2020.
Every year, 808 million people face catastrophic health expenditure (CHE), and 122 million people were pushed into poverty. It aggravates healthcare inequalities, incurs double burden opportunity costs, and pushes households to sit in a deep poverty trap. A few studies have been done so far; however, it is not enough to inform policy decisions. Therefore, this study aimed to assess the catastrophic out-of-pocket health expenditure and associated factors among rural households in Mandura District, Western Ethiopia.
We conducted a community-based cross-sectional study among the Mandura district's 488 rural households from April to May 2017. We used a multistage systematic sampling technique to select the participants. We fitted a binary logistic regression model to identify the factors associated with catastrophic out-of-pocket health expenditure. We used the adjusted odds ratio (AOR) with 95% CI and the p-value <0.05 to determine the variables associated with catastrophic out-of-pocket health expenditure.
Catastrophic health expenditure (CHE) with a 40% capacity to pay (CTP) households in the study area was 22.5%. Female household head (AOR = 2.92; 95% CI: 1.44, 5.93) and household with chronic illnesses (AOR = 3.93; 95% CI: 1.78, 9.14) were positively associated with CHE and, while households who had adult household members (AOR = 0.32; 95% CI: 0.16, 0.63) were negatively associated.
The overall CHE, with a 40% CTP threshold, was high. Prevention of chronic illness might help to reduce the burden of the expenditure. Strengthening financial risk protection mechanisms, such as community-based health insurance, could help bring healthcare services equity.
每年有8.08亿人面临灾难性医疗支出（CHE），1.22亿人因此陷入贫困。这加剧了医疗保健不平等，产生了双重负担机会成本，并使家庭陷入深度贫困陷阱。到目前为止，相关研究较少；然而，这些研究不足以支持政策决策。因此，本研究旨在评估埃塞俄比亚西部曼杜拉区农村家庭的灾难性自付医疗支出及相关因素。
2017年4月至5月，我们在曼杜拉区的488户农村家庭中开展了一项基于社区的横断面研究。我们采用多阶段系统抽样技术选取参与者。我们拟合了二元逻辑回归模型以识别与灾难性自付医疗支出相关的因素。我们使用调整后的比值比（AOR）及95%置信区间（CI）和p值<0.05来确定与灾难性自付医疗支出相关的变量。
在研究区域，支付能力（CTP）为40%的家庭中，灾难性医疗支出（CHE）为22.5%。女性户主家庭（AOR = 2.92；95% CI：1.44，5.93）和有慢性病的家庭（AOR = 3.93；95% CI：1.78，9.14）与CHE呈正相关，而有成年家庭成员的家庭（AOR = 0.32；95% CI：0.16，0.63）与CHE呈负相关。
以40% CTP为阈值的总体CHE较高。预防慢性病可能有助于减轻支出负担。加强基于社区的医疗保险等金融风险保护机制，有助于实现医疗服务公平。
