Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
Universidad de Buenos Aires, Buenos Aires, Argentina.
Int J Health Policy Manag. 2022 Oct 19;11(10):2299-2307. doi: 10.34172/ijhpm.2021.154. Epub 2021 Nov 7.
Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the coronavirus disease 2019 (COVID-19) pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post-mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status.
This study utilized repeated cross-sectional data from the National Household Survey on Living and Poverty Conditions (ENAHO) from the first quarter of 2017 until the fourth quarter of 2020. The outcomes were () the proportion of individuals who incurred OOP expenditures and () the monetary value of OOP expenditures. An interrupted time series analysis (ITS) and a quasi-experimental difference-in-difference (DID) analysis were performed to examine the outcomes among the control (individuals without health insurance) and treatment groups (individuals with health insurance) after the COVID-19 pandemic.
ITS analysis showed that the proportion of individuals reporting OOP expenditures after implementation of mandatory lockdown due to COVID-19 in Peru decreased in both groups, but no difference in the slope trend was found (=.916). The average quarterly amount of OOP spending increased in both groups, but no difference in the slope trend was found (=.073). Lastly, the DID analysis showed that the mandatory lockdown was associated with a higher amount of OOP, but there was no evidence to indicate that the higher amount was different between the control and treatment groups.
The mandatory lockdown in response to the COVID-19 was associated with a higher amount of OOP expenditures and a lower likelihood of incurring OOP expenditures. However, our findings suggest that health insurance coverage does not lower OOP expenditures or reduce the likelihood of incurring OOP expenditures.
健康保险预计可以保护个人免受自付费用（OOP）支出的影响，从而防止他们陷入贫困。然而，迄今为止，健康保险对 2020 年冠状病毒病（COVID-19）大流行期间 OOP 支出的影响尚未得到充分探索。本研究旨在根据健康保险覆盖情况，估算秘鲁人在 COVID-19 强制封锁前后的 OOP 支出比例和金额差异。
本研究使用了 2017 年第一季度至 2020 年第四季度期间全国家庭生活和贫困状况调查（ENAHO）的重复横断面数据。结果为（1）发生 OOP 支出的个人比例和（2）OOP 支出的货币价值。采用中断时间序列分析（ITS）和准实验差分（DID）分析方法，在 COVID-19 大流行后，对对照组（无健康保险的个人）和治疗组（有健康保险的个人）的结果进行检验。
ITS 分析表明，秘鲁在 COVID-19 强制封锁后，报告 OOP 支出的个人比例在两组中均有所下降，但斜率趋势没有差异（=0.916）。两组的 OOP 季度平均支出均有所增加，但斜率趋势没有差异（=0.073）。最后，DID 分析表明，强制封锁与 OOP 支出增加有关，但没有证据表明控制组和治疗组之间的 OOP 支出增加存在差异。
针对 COVID-19 的强制封锁与 OOP 支出增加和发生 OOP 支出的可能性降低有关。然而，我们的研究结果表明，健康保险并不能降低 OOP 支出或减少发生 OOP 支出的可能性。
