Iamshchikova Mariia, Mogilevskii Roman, Onah Michael Nnachebe
Institute of Public Policy and Administration, Graduate School of Development, University of Central Asia, Bishkek, Kyrgyzstan.
Int J Equity Health. 2021 Jan 11;20(1):30. doi: 10.1186/s12939-020-01358-2.
Over the years, the Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs, and the incidence of catastrophic health expenditure (CHE) post the "Manas Taalimi" and "Den Sooluk" health reforms.
We used data from the Kyrgyzstan Integrated Household Surveys (2012-2018). Population-weighted descriptive statistics were used to examine the trends in OOPPs and CHE at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40.
Between 2012 and 2018, OOPPs increased by about US $6 and inpatient costs placed the highest cost burden on users (US $13.6), followed by self-treatment (US $10.7), and outpatient costs (US $9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 - 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure.
The initial gains in the reduction of OOPPs and catastrophic health expenditure appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. This implies that households are increasingly incurring economic hardship from seeking healthcare. Considering that this could result to forgone expenditure on essential items including food and education, efforts should target the sustainability of these health reforms to maintain and grow the reduction of catastrophic health payments and its dire consequences.
多年来，吉尔吉斯共和国实施了以卫生筹资为目标的卫生改革，旨在消除包括自付医疗费用（OOPPs）在内的医疗保健财务障碍。本研究考察了“玛纳斯计划”和“健康生活”卫生改革后自付医疗费用的趋势以及灾难性卫生支出（CHE）的发生率。
我们使用了吉尔吉斯斯坦综合家庭调查（2012 - 2018年）的数据。采用人口加权描述性统计方法，在三个阈值下考察自付医疗费用和灾难性卫生支出的趋势；即家庭总消费支出的10%（Cata10）、家庭总消费支出的25%（Cata25）和家庭非食品消费支出的40%（Cata40）。使用具有边际效应的面板和横截面逻辑回归来考察Cata10和Cata40的预测因素。
2012年至2018年期间，自付医疗费用增加了约6美元，住院费用给使用者带来了最高的成本负担（13.6美元），其次是自我治疗（10.7美元）和门诊费用（9美元）。药品仍然是住院、门诊和自我治疗自付医疗费用的主要驱动因素。2012年至2018年期间，约有37.8万至208.4万人（占人口的6% - 33%）在这三个阈值下发生了灾难性卫生支出。居住在由寡妇或单身户主当家的家庭中，或居住在农村地区，会增加发生灾难性卫生支出的可能性。
自付医疗费用和灾难性卫生支出最初的减少成果似乎在逐渐消失，因为成本在最初下降后继续上升，灾难性卫生支出也持续不减地增加。这意味着家庭因寻求医疗保健而日益面临经济困难。考虑到这可能导致在包括食品和教育等基本项目上的支出减少，应致力于这些卫生改革的可持续性，以维持和扩大灾难性卫生支付的减少及其严重后果。
