Faculty of Economic Sciences and Management of Sousse, Tunisia.
National Institute of Labour and Social Studies, University of Carthage, Tunisia.
Value Health Reg Issues. 2022 Jul;30:109-118. doi: 10.1016/j.vhri.2022.01.008. Epub 2022 Mar 24.
This study aimed to estimate and analyze the effects of out-of-pocket expenditure attributed to medicine on catastrophic health expenditure (CHE) and impoverishment. Our study also explored the determinants of CHE for Tunisian households.
CHE and impoverishment were estimated using the representative sample of 25 087 households' survey of Budget, Consumption, and Living Standards in 2015. Logistic regression was applied to determine factors associated with the CHE.
The occurrence of catastrophic expenditure on health and medicine from the total population was, respectively, estimated to be 18.4% and 8.0%, whereas the impoverishment was 2.8% and 1.8%. The catastrophic expenditure was high in households having a chronic disease, disability, elderly, and children younger than 5 years and those living in a rural area. The rich and insured households are also experiencing financial hardship.
Out-of-pocket expenditure for medicine generates high levels of catastrophic and impoverishment in Tunisia. To achieve universal and affordable access to medicine, policy makers should remove fees at public facilities for patients with chronic diseases and disabilities, consolidate public procurement and distribution, and ensure effective reimbursement of health insurance.
本研究旨在估算和分析医疗自付支出对灾难性卫生支出（CHE）和贫困的影响。我们的研究还探讨了突尼斯家庭 CHE 的决定因素。
使用 2015 年预算、消费和生活水平代表性样本调查估计 CHE 和贫困情况。应用逻辑回归确定与 CHE 相关的因素。
从总人口来看，卫生和药品的灾难性支出发生率分别估计为 18.4%和 8.0%，而贫困发生率分别为 2.8%和 1.8%。有慢性病、残疾、老年人和 5 岁以下儿童的家庭以及居住在农村地区的家庭的灾难性支出较高。富裕和参保家庭也面临经济困难。
突尼斯的药品自付支出导致了高水平的灾难性支出和贫困。为了实现全民可负担得起的药品供应，政策制定者应取消慢性病和残疾患者在公共设施的费用，整合公共采购和分配，并确保医疗保险的有效报销。
