The World Bank, 1818 H. Street, NW, Washington, DC 20433, USA.
Department of Health Policy, London School of Economics and Political Science, 6 Portugal Street, London WC2A 2HD, UK.
Health Policy Plan. 2022 Jun 13;37(6):771-778. doi: 10.1093/heapol/czac024.
In addition to the direct health effects of the Coronavirus disease (COVID-19) pandemic, the pandemic has increased the risks of foregone non-COVID-19 healthcare. Likely, these risks are greatest in low- and middle-income countries (LMICs), where health systems are less resilient and economies more fragile. However, there are no published studies on the prevalence of foregone healthcare in LMICs during the pandemic. We used pooled data from phone surveys conducted between April and August 2020, covering 73 638 households in 39 LMICs. We estimated the prevalence of foregone care and the relative importance of various reported reasons for foregoing care, disaggregated by country income group and region. In the sample, 18.8% (95% CI 17.8-19.8%) of households reported not being able to access healthcare when needed. Financial barriers were the most-commonly self-reported reason for foregoing care, cited by 31.4% (28.6-34.3%) of households. More households in wealthier countries reported foregoing care for reasons related to COVID-19 [27.2% (22.5-31.8%) in upper-middle-income countries compared to 8.0% (4.7-11.3%) in low-income countries]; more households in poorer countries reported foregoing care due to financial reasons [65.6% (59.9-71.2%)] compared to 17.4% (13.1-21.6%) in upper-middle-income countries. A substantial proportion of households in LMICs had to forgo healthcare in the early months of the pandemic. While in richer countries this was largely due to fear of contracting COVID-19 or lockdowns, in poorer countries foregone care was due to financial constraints.
除了冠状病毒病（COVID-19）大流行对健康的直接影响外，大流行还增加了错过非 COVID-19 医疗保健的风险。在卫生系统弹性较差且经济较为脆弱的中低收入国家（LMIC），这些风险可能最大。然而，目前尚无关于大流行期间 LMIC 错过医疗保健的发生率的已发表研究。我们使用了 2020 年 4 月至 8 月间进行的电话调查的汇总数据，涵盖了 39 个 LMIC 中的 73638 户家庭。我们按国家收入组和地区对报告的各种放弃治疗原因进行了细分，估计了错过治疗的发生率和相对重要性。在该样本中，有 18.8%（95%CI17.8-19.8%）的家庭报告说在需要时无法获得医疗保健。经济障碍是最常被报告的放弃治疗的原因，有 31.4%（28.6-34.3%）的家庭这样说。较富裕国家的家庭报告因 COVID-19 相关原因而放弃治疗的比例更高[在中高收入国家为 27.2%（22.5-31.8%），而在低收入国家为 8.0%（4.7-11.3%）]；较贫穷国家的家庭报告因经济原因而放弃治疗的比例更高[65.6%（59.9-71.2%）]，而在中高收入国家为 17.4%（13.1-21.6%）。大流行早期，中低收入国家的大量家庭不得不放弃医疗保健。在较富裕的国家，这主要是由于担心感染 COVID-19 或封锁，而在较贫穷的国家，放弃治疗是由于经济限制。
