Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia.
Health Economics Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
Int J Equity Health. 2022 Dec 31;21(1):192. doi: 10.1186/s12939-022-01810-5.
Many high-income countries have made significant progress towards achieving universal health coverage. Nevertheless, out-of-pocket (OOP) health expenditure continues to undermine the effectiveness of the universal healthcare system. In Saudi Arabia, due to the overburdened free public health services, many people opt for alternative healthcare services, risking high OOP payments. The presence of chronic illness further exacerbates this situation. However, there is limited evidence on the extent of the gap in OOP health expenditure between the chronically and non-chronically ill and the associated drivers contributing to this gap. The aim of this study was to assess inequalities in relative OOP health expenditure, estimated as the percentage of income spent on healthcare, between the chronically and non-chronically ill in Saudi Arabia and their associated drivers.
Data from 10,785 respondents were obtained from a national cross-sectional survey conducted in Saudi Arabia as part of the 2018 Family Health Survey. Inequalities in relative OOP health expenditure were measured using concentration indices and curves. A Blinder-Oaxaca decomposition analysis was used to assess the differences in relative OOP health expenditure between the chronically and non-chronically ill.
The results showed that the chronically ill experience a higher financial burden due to healthcare services in absolute costs and relative to their income compared to the non-chronically ill. In addition, there was higher pro-poor inequality (-0.1985) in relative OOP health expenditure among the chronically ill compared to that (-0.1195) among the non-chronically ill. There was a 2.6% gap in relative OOP health expenditure among the chronically and non-chronically ill, of which 53.8% was attributable to unexplained factors, with explained factors accounting for the 46.2% difference. Factors that significantly contributed to the overall gap (i.e. both explained and non-explained factors) included employment status, insurance status, self-rated health, and periodic check-ups.
This study underscores the high financial burden due to OOP payments among the chronically ill and the existence of pro-poor inequalities. In addition, there is a significant gap in relative OOP health expenditure between the chronically and non-chronically ill, which is mainly attributable to differences in socio-economic characteristics. This indicates that the existing financial mechanisms have not been sufficient in cushioning the chronically ill and less well off in Saudi Arabia. This situation calls for health policymakers to integrate a social safety net into the health financing system and to prioritize the disadvantaged population, thereby ensuring access to health services without experiencing financial hardship.
许多高收入国家在实现全民健康覆盖方面取得了重大进展。然而，自付（OOP）卫生支出仍然破坏了全民医疗保健系统的有效性。在沙特阿拉伯，由于免费公共卫生服务负担过重，许多人选择替代医疗服务，冒着高额 OOP 支付的风险。慢性疾病的存在使这种情况进一步恶化。然而，关于慢性病患者和非慢性病患者之间 OOP 卫生支出差距的程度以及导致这种差距的相关驱动因素的证据有限。本研究旨在评估沙特阿拉伯慢性病患者和非慢性病患者之间相对 OOP 卫生支出的不平等程度，并评估相关驱动因素。
本研究的数据来自沙特阿拉伯 2018 年家庭健康调查的全国性横断面调查，共纳入了 10785 名受访者。使用集中指数和曲线来衡量相对 OOP 卫生支出的不平等程度。使用 Blinder-Oaxaca 分解分析来评估慢性病患者和非慢性病患者之间相对 OOP 卫生支出的差异。
结果显示，与非慢性病患者相比，慢性病患者在绝对医疗费用和相对收入方面都面临更高的医疗服务财务负担。此外，慢性病患者的相对 OOP 卫生支出呈现更高的贫困人口倾斜（-0.1985），而非慢性病患者的相对 OOP 卫生支出呈现更高的贫困人口倾斜（-0.1195）。慢性病患者和非慢性病患者之间的相对 OOP 卫生支出存在 2.6%的差距，其中 53.8%归因于无法解释的因素，46.2%的差异归因于可解释因素。显著导致总体差距的因素（即解释和非解释因素）包括就业状况、保险状况、自我评估健康状况和定期检查。
本研究强调了慢性病患者因自付支付而面临的高财务负担以及贫困人口倾斜的存在。此外，慢性病患者和非慢性病患者之间的相对 OOP 卫生支出存在显著差距，主要归因于社会经济特征的差异。这表明，沙特阿拉伯现有的财务机制在缓解慢性病患者和弱势群体方面还不够充分。这种情况需要卫生政策制定者将社会安全网纳入卫生融资系统，并优先考虑弱势群体，从而确保他们能够获得医疗服务，而不会面临经济困难。
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