Department of Economics, Nepal Commerce Campus, Tribhuvan University, Kathmandu, Nepal.
Public Health and Social Protection Professional, Kathmandu, Nepal.
PLoS One. 2023 Jan 27;18(1):e0280840. doi: 10.1371/journal.pone.0280840. eCollection 2023.
The low-and middle-income countries, including Nepal, aim to address the financial hardship against healthcare out-of-pocket (OOP) payments through various health financing reforms, for example, risk-pooling arrangements that cover different occupations. World Health Organization (WHO) has recommended member states to establish pooling arrangements so that the financial risks owing to health uncertainty can be spread across population. This study aims to analyse the situation of financial protection across occupations and geography using nationally representative annual household survey (AHS) in Nepal.
We measured catastrophic health expenditure (CHE) due to OOP using two popular approaches-budget share and capacity-to-pay, and impoverishment impact at absolute and relative poverty lines. This study is the first of its kind from south-east Asia to analyse disaggregated estimates of financial protection across occupations and geography. The inequality in financial risk protection was measured using concentration index. Data were extracted from AHS 2014-15 -a cross-sectional survey that used standard consumption measurement tool (COICOP) and International Standard Classification of Occupations (ISCO).
We found a CHE of 10.7% at 10% threshold and 5.2% at 40% threshold among households belonging to agricultural workers. The corresponding figures were 10% and 4.8% among 'plant operators and craft workers'. Impoverishment impact was also higher among these households at all poverty lines. In addition, CHE was higher among unemployed households. A negative concentration index was observed for CHE and impoverishment impact among agricultural workers and 'plant operators and craft workers'. In rural areas, we found a CHE of 11.5% at 10% threshold and a high impoverishment impact. Across provinces, CHE was 12% in Madhesh and 14.3% in Lumbini at 10% threshold, and impoverishment impact was 1.9% in Madhesh, Karnali and Sudurpachim at US $1.90 a day poverty line.
Households belonging to informal occupations were more prone to CHE and impoverishment impact due to healthcare OOP payments. Impoverishment impact was disproportionately higher among elementary occupations, agricultural workers, and 'plant operators and craft workers'. Similarly, the study found a wide urban/rural and provincial gap in financial protection. The results can be useful to policymakers engaged in designing health-financing reforms to make progress toward UHC.
包括尼泊尔在内的中低收入国家通过各种医疗融资改革，例如涵盖不同职业的风险共担安排，旨在解决医疗保健自费（OOP）支付带来的经济困难。世界卫生组织（WHO）建议成员国建立风险共担安排，以便将因健康不确定性而产生的财务风险在人群中分担。本研究旨在使用尼泊尔全国代表性年度家庭调查（AHS）分析不同职业和地理区域的财务保障状况。
我们使用两种流行的方法（预算份额和支付能力）衡量由于 OOP 导致的灾难性医疗支出（CHE），并根据绝对和相对贫困线衡量贫困影响。这是南亚首例分析职业和地理区域细分财务保障估计的研究。使用集中指数衡量财务风险保护的不平等。数据取自 AHS 2014-15 年，这是一项使用标准消费衡量工具（COICOP）和国际职业分类（ISCO）的横断面调查。
我们发现农业工人家庭的 CHE 为 10.7%（阈值为 10%）和 5.2%（阈值为 40%）。相应的数字是 10%和 4.8%，是“工厂经营者和手工艺工人”家庭的数字。在所有贫困线中，这些家庭的贫困影响也更高。此外，失业家庭的 CHE 更高。农业工人和“工厂经营者和手工艺工人”的 CHE 和贫困影响呈现负集中指数。在农村地区，我们发现 CHE 为 11.5%（阈值为 10%），贫困影响较大。在各省中，马德什的 CHE 为 12%，10%阈值时的 Lumbini 为 14.3%，在 US $1.90 天贫困线时，马德什、卡纳利和苏尔普尔查姆的贫困影响为 1.9%。
由于医疗保健自费支付，非正式职业的家庭更容易受到 CHE 和贫困影响。贫困影响在初等职业、农业工人和“工厂经营者和手工艺工人”中不成比例地更高。同样，该研究发现财务保障方面存在广泛的城乡和省级差距。研究结果可为参与设计医疗融资改革的政策制定者提供有用信息，以朝着全民健康覆盖的方向取得进展。
