Al-Hanawi Mohammed Khaled, Mwale Martin Limbikani, Qattan Ameerah M N
Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Cape Town, South Africa.
Front Pharmacol. 2021 Apr 30;12:638035. doi: 10.3389/fphar.2021.638035. eCollection 2021.
Achieving universal health coverage is an important objective enshrined in the 2015 global Sustainable Development Goals. However, the rising cost of healthcare remains an obstacle to the attainment of the universal health coverage. Health insurance is considered an option to reduce out-of-pocket (OOP) expenditure on health and medicine. Nevertheless, the relationship between insurance and the OOP along welfare distributions is not well understood. This study investigates the heterogeneous association between health insurance and OOP expenditure on health and medicine, along income, using data from the Kingdom of Saudi Arabia. This study used data of 8655 individuals drawn from the Saudi Family Health Survey conducted in 2018. The study adopts Tobit models to account for possible corner solution due to individuals with zero expenditure on health. We minimize the confounding effects of non-random selection into the insurance program by estimating the Tobit equations on a sample weighted by inverse propensity scores of insurance participation. In addition, we test whether the health insurance differently relates to OOP on health and medicine amongst people with access to free medical care as opposed to those without this privilege. The study estimates separate models for OOP expenditure on health and on medicines. Health insurance reduces OOP expenditure on health by 2.0% and OOP expenditure on medicine by 2.4% amongst the general population while increasing the OOP expenditure on health by 0.2% and OOP expenditure on medicine by 0.2%, once income of the insured rises. The relationship between the insurance and OOP expenditure is robust only amongst the citizens, a sub-sample that also has access to free public healthcare. Specifically, the insurance reduces OOP expenditure on health by 3.6% and OOP on medicine by 5.2% and increases OOP expenditure on health by 0.4% and OOP expenditure on medicine by 0.5% once income of the insured increases amongst Saudi citizens. In addition, targeting medicines can lead to greater changes in OOP. The relationship between insurance and OOP is stronger for medicine relative to that observed on health expenditure. Our findings suggest that insurance induces different effects along the income spectrum. Hence, policy needs to be aware of the possible welfare distribution impacts of upscaling or downscaling the coverage of insurance amongst the populations, while pursuing universal healthcare coverage.
实现全民健康覆盖是2015年全球可持续发展目标中确立的一项重要目标。然而，医疗保健成本的不断上升仍然是实现全民健康覆盖的一个障碍。健康保险被视为减少医疗和药品自付费用的一种选择。然而，保险与自付费用在福利分配方面的关系尚未得到充分理解。本研究利用沙特阿拉伯王国的数据，调查了健康保险与医疗和药品自付费用之间在收入方面的异质性关联。本研究使用了从2018年进行的沙特家庭健康调查中抽取的8655名个体的数据。该研究采用托比特模型来处理因健康支出为零的个体可能出现的角点解问题。我们通过在由保险参与的逆倾向得分加权的样本上估计托比特方程，将非随机选择进入保险计划的混杂效应降至最低。此外，我们测试了在有免费医疗服务的人群与没有这种特权的人群中，健康保险与医疗和药品自付费用的关系是否不同。该研究分别估计了医疗和药品自付费用的模型。在普通人群中，健康保险使医疗自付费用降低了2.0%，药品自付费用降低了2.4%，而一旦被保险人的收入增加，医疗自付费用会增加0.2%，药品自付费用会增加0.2%。保险与自付费用之间的关系仅在公民中稳健，公民这一子样本也可获得免费的公共医疗服务。具体而言，在沙特公民中，一旦被保险人的收入增加，保险使医疗自付费用降低3.6%，药品自付费用降低5.2%，医疗自付费用增加0.4%，药品自付费用增加0.5%。此外，针对药品可能会导致自付费用发生更大变化。相对于医疗支出而言，保险与药品自付费用之间的关系更强。我们的研究结果表明，保险在收入范围内会产生不同的影响。因此，在追求全民医疗覆盖的同时，政策需要意识到扩大或缩小保险覆盖范围可能对人群福利分配产生的影响。
