Heidelberg Institute of Global Health, University Hospital & Medical Faculty, Heidelberg University, Heidelberg, Germany.
Department of Economics, University of Zambia, Lusaka, Zambia.
BMC Public Health. 2022 Aug 13;22(1):1546. doi: 10.1186/s12889-022-13923-1.
Zambia has invested in several healthcare financing reforms aimed at achieving universal access to health services. Several evaluations have investigated the effects of these reforms on the utilization of health services. However, only one study has assessed the distributional incidence of health spending across different socioeconomic groups, but without differentiating between public and overall health spending and between curative and maternal health services. Our study aims to fill this gap by undertaking a quasi-longitudinal benefit incidence analysis of public and overall health spending between 2006 and 2014.
We conducted a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies at three time points. We combined data from household surveys and National Health Accounts.
Results showed that public (concentration index of - 0.003; SE 0.027 in 2006 and - 0.207; SE 0.011 in 2014) and overall (0.050; SE 0.033 in 2006 and - 0.169; SE 0.011 in 2014) health spending on curative services tended to benefit the poorer segments of the population while public (0.241; SE 0.018 in 2007 and 0.120; SE 0.007 in 2014) and overall health spending (0.051; SE 0.022 in 2007 and 0.116; SE 0.007 in 2014) on institutional delivery tended to benefit the least-poor. Higher inequalities were observed at higher care levels for both curative and institutional delivery services.
Our findings suggest that the implementation of UHC policies in Zambia led to a reduction in socioeconomic inequality in health spending, particularly at health centres and for curative care. Further action is needed to address existing barriers for the poor to benefit from health spending on curative services and at higher levels of care.
赞比亚投资了多项医疗保健融资改革，旨在实现全民获得卫生服务。有几项评估调查了这些改革对卫生服务利用的影响。然而，只有一项研究评估了卫生支出在不同社会经济群体之间的分布情况，但没有区分公共卫生支出和总卫生支出，以及治疗和孕产妇保健服务。我们的研究旨在通过对 2006 年至 2014 年期间的公共卫生支出和总卫生支出进行准纵向受益情况分析来填补这一空白。
我们进行了受益情况分析（BIA），以衡量不同卫生机构类型在三个时间点的治疗服务和机构分娩方面的公共和总卫生支出的社会经济不平等情况。我们将家庭调查和国家卫生账户的数据结合起来。
结果表明，公共卫生支出（2006 年的集中指数为-0.003，SE 为 0.027；2014 年为-0.207，SE 为 0.011）和总卫生支出（2006 年为 0.050，SE 为 0.033；2014 年为-0.169，SE 为 0.011）对治疗服务的支出往往有利于人口中的贫困阶层，而公共卫生支出（2007 年的 0.241，SE 为 0.018；2014 年的 0.120，SE 为 0.007）和总卫生支出（2007 年的 0.051，SE 为 0.022；2014 年的 0.116，SE 为 0.007）对机构分娩的支出往往有利于最贫困阶层。在治疗和机构分娩服务方面，较高的服务水平导致了更高的不平等。
我们的研究结果表明，赞比亚实施全民健康覆盖政策导致卫生支出的社会经济不平等程度降低，特别是在卫生中心和治疗方面。需要进一步采取行动，为穷人提供治疗服务和更高水平的医疗保健服务，以解决其受益于卫生支出的现有障碍。
