Binyaruka Peter, Borghi Josephine
Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Health Econ Rev. 2022 Jul 8;12(1):36. doi: 10.1186/s13561-022-00387-7.
Direct and time costs of accessing and using health care may limit health care access, affect welfare loss, and lead to catastrophic spending especially among poorest households. To date, limited attention has been given to time and transport costs and how these costs are distributed across patients, facility and service types especially in poor settings. We aimed to fill this knowledge gap.
We used data from 1407 patients in 150 facilities in Tanzania. Data were collected in January 2012 through patient exit-interviews. All costs were disaggregated across patients, facility and service types. Data were analysed descriptively by using means, medians and equity measures like equity gap, ratio and concentration index.
71% of patients, especially the poorest and rural patients, accessed care on foot. The average travel time and cost were 30 minutes and 0.41USD respectively. The average waiting time and consultation time were 47 min and 13 min respectively. The average medical cost was 0.23 USD but only18% of patients paid for health care. The poorest and rural patients faced substantial time burden to access health care (travel and waiting) but incurred less transport and medical costs compared to their counterparts. The consultation time was similar across patients. Patients spent more time travelling to public facilities and dispensaries while incurring less transport cost than accessing other facility types, but waiting and consultation time was similar across facility types. Patients paid less amount in public than in private facilities. Postnatal care and vaccination clients spent less waiting and consultation time and paid less medical cost than antenatal care clients.
Our findings reinforce the need for a greater investment in primary health care to reduce access barriers and cost burdens especially among the worse-offs. Facility's construction and renovation and increased supply of healthcare workers and medical commodities are potential initiatives to consider. Other initiatives may need a multi-sectoral collaboration.
获取和使用医疗保健的直接成本和时间成本可能会限制医疗保健的可及性，影响福利损失，并导致灾难性支出，尤其是在最贫困家庭中。迄今为止，人们对时间和交通成本以及这些成本如何在患者、医疗机构和服务类型之间分配的关注有限，尤其是在贫困地区。我们旨在填补这一知识空白。
我们使用了来自坦桑尼亚150个医疗机构中1407名患者的数据。数据于2012年1月通过患者出院访谈收集。所有成本均按患者、医疗机构和服务类型进行分类。通过使用均值、中位数以及公平差距、比率和集中指数等公平性指标对数据进行描述性分析。
71%的患者，尤其是最贫困和农村患者，步行前往就医。平均出行时间和成本分别为30分钟和0.41美元。平均等待时间和咨询时间分别为47分钟和13分钟。平均医疗费用为0.23美元，但只有18%的患者支付医疗费用。最贫困和农村患者在获取医疗保健方面面临巨大的时间负担（出行和等待），但与其他患者相比，他们的交通和医疗费用较低。患者的咨询时间相似。患者前往公共医疗机构和诊疗所花费的时间更多，交通成本低于前往其他类型医疗机构，但等待和咨询时间在不同类型医疗机构中相似。患者在公共医疗机构支付的费用低于私立医疗机构。与产前护理患者相比，产后护理和疫苗接种患者的等待和咨询时间较短，支付的医疗费用也较少。
我们的研究结果强调了加大对初级卫生保健投资的必要性，以减少获取障碍和成本负担，尤其是在弱势群体中。医疗机构的建设和翻新以及增加医护人员和医疗用品的供应是可以考虑的潜在举措。其他举措可能需要多部门合作。
