Swiss Tropical and Public Health Institute, Allschwil, Switzerland
Universität Basel, Basel, Basel-Stadt, Switzerland.
BMJ Glob Health. 2022 May;7(5). doi: 10.1136/bmjgh-2022-008722.
Several low-income and middle-income countries (LMICs) have implemented health insurance programmes to foster accessibility to healthcare and reduce catastrophic household health expenditure. However, there is little information regarding the population coverage of health insurance schemes in LMICs and on the relationship between coverage and health expenditure. This study used open-access data to assess the level of health insurance coverage in LMICs and its relationship with health expenditure.
We searched for health insurance data for all LMICs and combined this with health expenditure data. We used descriptive statistics to explore levels of and trends in health insurance coverage over time. We then used linear regression models to investigate the relationship between health insurance coverage and sources of health expenditure and catastrophic household health expenditure.
We found health insurance data for 100 LMICs and combined this with overall health expenditure data for 99 countries and household health expenditure data for 89 countries. Mean health insurance coverage was 31.1% (range: 0%-98.7%), with wide variations across country-income groups. Average health insurance coverage was 7.9% in low-income countries, 27.3% in lower middle-income countries and 52.5% in upper middle-income countries. We did not find any association between health insurance coverage and health expenditure overall, though coverage was positively associated with public health spending. Additionally, health insurance coverage was not associated with levels of or reductions in catastrophic household health expenditure or impoverishment due to health expenditure.
These findings indicate that LMICs continue to have low levels of health insurance coverage and that health insurance may not necessarily reduce household health expenditure. However, the lack of regular estimates of health insurance coverage in LMICs does not allow us to draw solid conclusions on the relationship between health insurance coverage and health expenditure.
一些低收入和中等收入国家（LMICs）已经实施了医疗保险计划，以促进医疗保健的可及性并减少灾难性的家庭医疗支出。然而，关于 LMICs 中医疗保险计划的覆盖人群以及覆盖范围与医疗支出之间的关系，信息很少。本研究使用公开获取的数据评估了 LMICs 中医疗保险覆盖水平及其与医疗支出的关系。
我们搜索了所有 LMICs 的医疗保险数据，并将其与医疗支出数据相结合。我们使用描述性统计数据来探讨随时间推移的医疗保险覆盖水平和趋势。然后，我们使用线性回归模型来调查医疗保险覆盖范围与医疗支出来源和灾难性家庭医疗支出之间的关系。
我们找到了 100 个 LMICs 的医疗保险数据，并将其与 99 个国家的总体医疗支出数据和 89 个国家的家庭医疗支出数据相结合。医疗保险覆盖的平均水平为 31.1%（范围：0%-98.7%），国家收入组之间存在很大差异。低收入国家的平均医疗保险覆盖率为 7.9%，中低收入国家为 27.3%，中高收入国家为 52.5%。我们没有发现医疗保险覆盖范围与总体医疗支出之间存在任何关联，尽管覆盖范围与公共卫生支出呈正相关。此外，医疗保险覆盖范围与灾难性家庭医疗支出或因医疗支出而致贫的水平或减少无关。
这些发现表明，LMICs 的医疗保险覆盖水平仍然很低，医疗保险不一定能降低家庭医疗支出。然而，由于缺乏对 LMICs 中医疗保险覆盖范围的定期估计，我们无法对医疗保险覆盖范围与医疗支出之间的关系得出确凿的结论。
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