Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
Global Development Policy Center, Boston University, Boston, Massachusetts, United States of America.
PLoS One. 2022 Sep 16;17(9):e0274671. doi: 10.1371/journal.pone.0274671. eCollection 2022.
High out-of-pocket expenditures (OOPE) increases the probability that households will become impoverished or will forgo needed care. The aim of this paper is to study household medicines expenditure and its associated determining factors to develop policies to protect households from financial hardship.
The present cross-sectional and population-level study used the Bangladesh 2016-17 National Household Income and Expenditure Survey (HIES). The final sample size was 46,080 households. We analyzed the probability of OOPE for medicines, the share of total OOPE due to medicines out of total OOPE in health (reported as a ratio between zero and one), the OOPE amount for medicines reported (in United States Dollars), and the share of OOPE amount on medicines out of total household expenditure (reported as a ratio between zero and one). Predictors of analyzed outcomes were identified using three regression models.
Out of those households who spent on healthcare, the probability of having any OOPE on medicines was 87.9%. Of those who spent on medicines, the median monthly expenditure was US$3.03. The poorest households spent 9.97% of their total household expenditure as OOPE on medicines, nearly double that of the wealthiest households (5.86%). The characteristic which showed the most significant correlation to a high OOPE on medicines was the presence of chronic diseases, especially cancer. Twenty six percent of all surveyed households spend more than 10% of their OOPE on medicines.
Our study shows that financial protection should be targeted at the poorest quintiles and such protection should include enrollment of rural households. Further, outpatient medicines benefits should include those for non-communicable diseases (NCDs).
自付费用过高（OOPE）增加了家庭贫困或放弃必要医疗的可能性。本文旨在研究家庭药品支出及其相关决定因素，制定保护家庭免受经济困难的政策。
本横断面和人群水平研究使用了孟加拉国 2016-17 年国家家庭收入和支出调查（HIES）。最终样本量为 46080 户家庭。我们分析了药品 OOPE 的可能性、药品总 OOPE 占药品总 OOPE 的比例（报告为零到一之间的比值）、报告的药品 OOPE 金额（以美元计）以及药品 OOPE 金额占家庭总支出的比例（报告为零到一之间的比值）。使用三个回归模型确定分析结果的预测因素。
在那些在医疗保健上有支出的家庭中，有药品 OOPE 的家庭占 87.9%。在那些有药品支出的家庭中，每月支出中位数为 3.03 美元。最贫困家庭的药品总支出占家庭总支出的 9.97%，几乎是最富裕家庭的两倍（5.86%）。与高药品 OOPE 相关性最大的特征是存在慢性病，尤其是癌症。26%的被调查家庭将超过 10%的 OOPE 用于药品。
我们的研究表明，财务保护应针对最贫困的五分之一人口，并且这种保护应包括农村家庭的参保。此外，门诊药品福利应包括非传染性疾病（NCDs）。
