Tulane University, School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
Emory University, Rollins School of Public Health, Atlanta, Georgia, United States of America.
PLoS Negl Trop Dis. 2021 Nov 23;15(11):e0009894. doi: 10.1371/journal.pntd.0009894. eCollection 2021 Nov.
This study presents a methodology for using tracer indicators to measure the effects of disease-specific programs on national health systems. The methodology is then used to analyze the effects of Bangladesh's Lymphatic Filariasis Elimination Program, a disease-specific program, on the health system. Using difference-in-differences models and secondary data from population-based household surveys, this study compares changes over time in the utilization rates of eight essential health services and incidences of catastrophic health expenditures between individuals and households, respectively, of lymphatic filariasis hyper-endemic districts (treatment districts) and of hypo- and non-endemic districts (control districts). Utilization of all health services increased from year 2000 to year 2014 for the entire population but more so for the population living in treatment districts. However, when the services were analyzed individually, the difference-in-differences between the two populations was insignificant. Disadvantaged populations (i.e., populations that lived in rural areas, belonged to lower wealth quintiles, or did not attend school) were less likely to access essential health services. After five years of program interventions, households in control districts had a lower incidence of catastrophic health expenditures at several thresholds measured using total household expenditures and total non-food expenditures as denominators. Using essential health service coverage rates as outcome measures, the Lymphatic Filariasis Elimination Program cannot be said to have strengthened or weakened the health system. We can also say that there is a positive association between the Lymphatic Filariasis Elimination Program's interventions and lowered incidence of catastrophic health expenditures.
本研究提出了一种使用示踪剂指标来衡量特定疾病计划对国家卫生系统影响的方法。然后，该方法被用于分析孟加拉国淋巴丝虫病消除计划（一种特定疾病计划）对卫生系统的影响。本研究使用双重差分模型和基于人群的家庭调查的二手数据，比较了淋巴丝虫病高度流行地区（治疗地区）和低度及非流行地区（对照地区）个人和家庭在八年基本卫生服务利用率和灾难性卫生支出发生率方面的随时间变化情况。所有卫生服务的利用率在 2000 年至 2014 年间均有所增加，但治疗地区的人口增加更为明显。然而，当对这些服务进行单独分析时，两种人群之间的差异并不显著。弱势群体（即居住在农村地区、属于较低财富五分位数或未上学的人群）不太可能获得基本卫生服务。在五年的项目干预后，使用家庭总支出和非食品总支出作为分母来衡量的几个阈值下，对照地区的家庭灾难性卫生支出发生率较低。使用基本卫生服务覆盖率作为结果衡量指标，不能说淋巴丝虫病消除计划加强或削弱了卫生系统。我们还可以说，淋巴丝虫病消除计划的干预措施与灾难性卫生支出发生率降低之间存在正相关关系。
