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家庭医疗保健融资方式:尼日利亚西南部一家三级医院儿科急诊科收治患者的社会地位差异、经济影响及临床结局

Households Health Care Financing Methods: Social Status Differences, Economic Implications and Clinical Outcomes Among Patients Admitted in a Pediatric Emergency Unit of a Tertiary Hospital in South West Nigeria.

作者信息

Taiwo Adekunle Bamidele, Fatunla Odunayo Adebukola, Ogundare Olatunde Ezra, Oluwayemi Oludare Isaac, Babatola Adefunke Olarinre, Ajite Adebukola Bidemi, Ajibola Ayotunde Emmanuel, Olajuyin Adebola, Sola-Oniyide Boluwatife, Olatunya Oladele Simeon

机构信息

Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.

Zankli Medical Services, Utako, Abuja, Nigeria.

出版信息

Glob Pediatr Health. 2023 Mar 11;10:2333794X231159792. doi: 10.1177/2333794X231159792. eCollection 2023.

Abstract

. The affordability of health care services by households within a country is determined by the health care financing methods used by her citizens. In accordance with World Health Organization (WHO), health services must be delivered equitably and without imposing financial hardship on the citizens. . This study aimed to determine the pattern of households health care financing method and relate it to the social-background, economic implication and clinical outcome of care in pediatric emergency situations. : It is a cross-sectional descriptive study. . 210 children from different households were recruited. Majority (75.9%) of the children were aged 0 to 5 years, males (61.2%) and belonged to the low socio-economic status (95.7%). The overall median (IQR) cost of care, income and percentage of income spent on care were ₦10 700 (₦7580-₦19 700), ₦ 65000(₦38000-₦110 000) and 17.6% (7.1%-39.7%) respectively. Though 70 (34.8%) of the respondents were aware of health insurance scheme, only 12.8% were enrolled. There were significant differences in the households' health care financing methods with respect to the socioeconomic status ( = .010), paternal level of education ( < .001), maternal occupation ( = .020), paternal occupation ( = .030) and distribution of income ( < .001). Catastrophic spending was experienced by 67.4% of the household, all of whom paid via out-of-pocket payment (OOPP) ( < .001), catastrophic health spending (CHS) was significantly associated with death and discharge against medical advice (DAMA) ( = .023). All cases of mortality and 93% cases of DAMA occurred with paying out of pocket (OOP) ( = .168). . health care services were majorly paid for OOP among households in this study and CHS are high among these households. Clinical and financial outcomes were worse when health care services were paid through OOP.

摘要

一个国家内家庭对医疗保健服务的可承受能力取决于其公民所采用的医疗保健筹资方式。根据世界卫生组织(WHO)的说法,医疗服务必须公平提供,且不给公民带来经济困难。 本研究旨在确定家庭医疗保健筹资方式的模式,并将其与儿科急诊情况下的社会背景、经济影响和护理临床结果联系起来。 这是一项横断面描述性研究。 招募了来自不同家庭的210名儿童。大多数(75.9%)儿童年龄在0至5岁之间,男性占61.2%,且属于社会经济地位较低的群体(95.7%)。护理的总体中位数(IQR)费用、收入以及护理支出占收入的百分比分别为10700奈拉(7580 - 19700奈拉);65000奈拉(38000 - 110000奈拉)以及17.6%(7.1% - 39.7%)。尽管70名(34.8%)受访者知晓医疗保险计划,但只有12.8%的人参保。家庭医疗保健筹资方式在社会经济地位(P = 0.010)、父亲教育水平(P < 0.001);母亲职业(P = 0.020)、父亲职业(P = 0.030)以及收入分配(P < 0.001)方面存在显著差异。67.4%的家庭经历了灾难性支出,他们均通过自付费用(OOPP)支付(P < 0.001),灾难性医疗支出(CHS)与死亡和违反医嘱出院(DAMA)显著相关(P = 0.023)。所有死亡病例以及93%的违反医嘱出院病例均发生在自付费用(OOP)的情况下(P = 0.168)。 在本研究中,家庭主要通过自付费用支付医疗保健服务费用,且这些家庭的灾难性医疗支出较高。当通过自付费用支付医疗保健服务费用时,临床和财务结果更差。

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