Mulaga Atupele N, Kamndaya Mphatso S, Masangwi Salule J
Department of Mathematics and Statistics, Faculty of Applied Sciences, University of Malawi, Blantyre, Malawi.
School of Science and Technology, Malawi University of Business and Applied Sciences, Blantyre, Malawi.
PLOS Glob Public Health. 2022 Feb 8;2(2):e0000182. doi: 10.1371/journal.pgph.0000182. eCollection 2022.
Reducing health inequalities and inequities is one of the key goals that health systems aspire to achieve as it ensures improvement in health outcomes among all population groups. Addressing the factors contributing to inequality in catastrophic health expenditures is important to reducing inequality in the burden of health expenditures. However, there are limited studies to explain the factors contributing to inequalities in catastrophic health expenditures. The study aimed to measure and decompose socio-economic inequality in catastrophic health into its determinants. Data for the analysis come from the fourth integrated household survey. Data for 12447 households in Malawi were collected from April 2016 to April 2017 by the National Statistical Office. The secondary analysis was conducted from June 2021 to October 2021. Catastrophic health expenditure was estimated as a proportion of households whose out-of-pocket health expenditures as a ratio of non-food consumption expenditures exceeds 40% threshold level. We estimated the magnitude of socio-economic inequality using the Erreygers corrected concentration index and used decomposition analysis to assess the contribution of inequality in each determinant of catastrophic health expenditure to the overall socio-economic inequality. The magnitude of the Erreygers corrected concentration index of catastrophic health expenditure (CI = 0.004) is small and positive which indicates that inequality is concentrated among the better-off. Inequality in catastrophic health expenditure is largely due to inequalities in rural residency (127%), socio-economic status (-40%), household size (14%), presence of a child under five years old (10%) and region of the household (10%). The findings indicate that socio-economic inequality in catastrophic health expenditures is concentrated among the better-off in Malawi. The results imply that policies that aim to reduce inequalities in catastrophic health expenditures should simultaneously address urban-rural and income inequalities.
减少健康不平等是卫生系统渴望实现的关键目标之一，因为这能确保所有人群的健康状况得到改善。解决导致灾难性卫生支出不平等的因素对于减少卫生支出负担的不平等至关重要。然而，解释导致灾难性卫生支出不平等的因素的研究有限。该研究旨在衡量并将灾难性卫生支出中的社会经济不平等分解为其决定因素。分析数据来自第四次综合住户调查。2016年4月至2017年4月，马拉维国家统计局收集了12447户家庭的数据。二次分析于2021年6月至2021年10月进行。灾难性卫生支出估计为自付卫生支出占非食品消费支出的比例超过40%这一门槛水平的家庭比例。我们使用埃雷格斯校正集中指数估计社会经济不平等的程度，并使用分解分析评估灾难性卫生支出各决定因素中的不平等对总体社会经济不平等的贡献。灾难性卫生支出的埃雷格斯校正集中指数（CI = 0.004）数值较小且为正，这表明不平等集中在较富裕人群中。灾难性卫生支出的不平等在很大程度上归因于农村居住状况的不平等（127%）、社会经济地位的不平等（-40%）、家庭规模的不平等（14%）、家中有五岁以下儿童的不平等（10%）以及家庭所在地区的不平等（10%）。研究结果表明，马拉维灾难性卫生支出中的社会经济不平等集中在较富裕人群中。结果意味着，旨在减少灾难性卫生支出不平等的政策应同时解决城乡不平等和收入不平等问题。
