Chen Chu, Chen Ting, Pan Jie
School of Health Management, Fujian Medical University, Fuzhou 350000, China.
Healthcare Evaluation and Organizational Analysis Group, West China School of Public Health and West China Fourth Hospital, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2023 Mar;54(2):393-399. doi: 10.12182/20230360105.
To evaluate the effect of Health Poverty Alleviation Project on the economic burden of disease among poor families and to provide references for further improvement of the Health Poverty Alleviation Project.
The difference-in-differences with propensity score matching method was used to analyze 48 counties in Sichuan Province. Propensity score matching was first carried out with data from the Sichuan Provincial Information System for Medical Care for Low-Income Population and the New Rural Cooperative Medical Insurance data to identify the non-poor population closest to the poor population. Then, difference-in-difference method was used to determine the effect of the Health Poverty Alleviation Project.
Health Poverty Alleviation Project reduced the total annual out-of-pocket (OOP) payments by 13.1% on average, the outpatient OOP payments by an average 2.4%, inpatient OOP payments by an average 19.5%, and the probability of incurring catastrophic health care expenditures by an average of 3.9% for low-income households. In addition, the program had a more significant effect in poverty-stricken counties than it did in non-poverty-stricken counties. Despite the significant effectiveness of the project, 12.1% of the low-income families still incurred catastrophic health expenditures after the program was implemented.
Health Poverty Alleviation Project reduces the economic burden of disease for poor households, and it has a better effect on reducing the economic burden of poor households in poverty-stricken counties. However, a certain number of households still incurred catastrophic health expenditures. When consolidating and expanding the effects of Health Poverty Alleviation Project and monitoring medical expenses for poverty prevention, policymakers should focus on the households with catastrophic medical expenditures to prevent them from sinking back into poverty.
评估健康扶贫项目对贫困家庭疾病经济负担的影响，为进一步完善健康扶贫项目提供参考。
采用倾向得分匹配法的双重差分法对四川省48个县进行分析。首先利用四川省低收入人群医疗信息系统数据和新型农村合作医疗数据进行倾向得分匹配，以确定与贫困人口最接近的非贫困人口。然后，采用双重差分法确定健康扶贫项目的效果。
健康扶贫项目使低收入家庭年自付费用总额平均降低了13.1%，门诊自付费用平均降低了2.4%，住院自付费用平均降低了19.5%，灾难性卫生支出发生概率平均降低了3.9%。此外，该项目在贫困县的效果比非贫困县更显著。尽管该项目取得了显著成效，但仍有12.1%的低收入家庭在项目实施后发生了灾难性卫生支出。
健康扶贫项目减轻了贫困家庭的疾病经济负担，对减轻贫困县贫困家庭的经济负担效果更佳。然而，仍有一定数量的家庭发生了灾难性卫生支出。在巩固和扩大健康扶贫项目成效以及监测预防贫困的医疗费用时，政策制定者应关注发生灾难性医疗支出的家庭，防止其再度陷入贫困。
