Population Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
J Public Health (Oxf). 2022 Jun 27;44(2):428-437. doi: 10.1093/pubmed/fdab021.
An insight into variation in financial protection among countries and the underpinning factors associated with the variations observed will help to inform public health policy and practice.
Secondary datasets from Global Health Expenditure Database and World Bank Development Indicators collected between 2000 and 2016 were used. Financial protection was measured in 75 low- and middle-income countries (LMICs) using the sustainable development goals framework. Funnel plot charts were used to explore the variation, and regression models were used to measure associations.
Fifty-three (67%) countries were within the 99% control limits indicating common-cause variation; 11 countries were above the upper control limit and 15 countries were below the lower control limit. In the fully adjusted model, country, spending on health relative to their economy had the strongest association with the variation in catastrophic spending. Every 1% increase in health spending relative to gross domestic product (GDP) was found to be associated with a reduction of 0.13% in the number of people that incurred catastrophic health spending.
There is substantial variation in financial protection, as measured by the number of people that incurred catastrophic health spending, in LMICs; a proportion of this could be explained by the difference in GDP and external health expenditure.
深入了解各国之间在财务保障方面的差异，以及与观察到的差异相关的潜在因素，将有助于为公共卫生政策和实践提供信息。
使用了全球卫生支出数据库和世界银行发展指标的二次数据集，这些数据收集于 2000 年至 2016 年之间。在 75 个低收入和中等收入国家（LMICs）中，使用可持续发展目标框架来衡量财务保障。使用漏斗图来探索差异，并使用回归模型来衡量关联。
53 个（67%）国家处于 99%控制限内，表明存在共同原因的变化；11 个国家高于上限控制限，15 个国家低于下限控制限。在完全调整的模型中，国家和卫生支出相对于经济的水平与灾难性支出变化的关联最强。发现卫生支出相对于国内生产总值（GDP）每增加 1%，就会有 0.13%的人减少灾难性的卫生支出。
在 LMICs 中，衡量灾难性卫生支出人数的财务保障存在着大量的差异；这种差异的一部分可以用 GDP 和外部卫生支出的差异来解释。
