Serván-Mori Edson, Orozco-Núñez Emanuel, Guerrero-López Carlos M, Miranda J Jaime, Jan Stephen, Downey Laura, Feeny Emma, Heredia-Pi Ileana, Flamand Laura, Nigenda Gustavo, Norton Robyn, Lozano Rafael
Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico.
The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
Health Syst Reform. 2023 Dec 31;9(1):2183552. doi: 10.1080/23288604.2023.2183552.
Latin America has experienced a rise in noncommunicable diseases (NCDs) which is having repercussions on the structuring of healthcare delivery and social protection for vulnerable populations. We examined catastrophic (CHE) and excessive (EHE, impoverishing and/or catastrophic) health care expenditures in Mexican households with and without elderly members (≥65 years), by gender of head of the households, during 2000-2020. We analyzed pooled cross-sectional data for 380,509 households from eleven rounds of the National Household Income and Expenditure Survey. Male- and female-headed households (MHHs and FHHs) were matched using propensity scores to control for gender bias in systematic differences regarding care-seeking (demand for healthcare) preferences. Adjusted probabilities of positive health expenditures, CHE and EHE were estimated using probit and two-stage probit models, respectively. Quintiles of EHE by state among FHHs with elderly members were also mapped. CHE and EHE were greater among FHHs than among MHHs (4.7% vs 3.9% and 5.5% vs 4.6%), and greater in FHHs with elderly members (5.8% vs 4.9% and 6.9% vs 5.8%). EHE in FHHs with elderly members varied geographically from 3.9% to 9.1%, being greater in less developed eastern, north-central and southeastern states. Compared with MHHs, FHHs face greater risks of CHE and EHE. This vulnerability is exacerbated in FHHs with elderly members, because of gender intersectional vulnerability. The present context, marked by a growing burden of NCDs and inequities amplified by COVID-19, makes key interlinkages across multiple Sustainable Development Goals (SDGs) apparent, and calls for urgent measures that strengthen social protection in health.
拉丁美洲非传染性疾病（NCDs）呈上升趋势，这对弱势群体的医疗服务提供和社会保护结构产生了影响。我们研究了2000年至2020年期间，墨西哥有和没有老年成员（≥65岁）的家庭中，按户主性别划分的灾难性（CHE）和过度（EHE，致贫和/或灾难性）医疗支出情况。我们分析了来自全国家庭收入和支出调查11轮的380,509户家庭的汇总横断面数据。使用倾向得分对以男性和女性为户主的家庭（MHHs和FHHs）进行匹配，以控制在就医（医疗保健需求）偏好的系统差异中的性别偏见。分别使用probit模型和两阶段probit模型估计了正向医疗支出、CHE和EHE的调整概率。还绘制了有老年成员的FHHs中按州划分的EHE五分位数图。FHHs中的CHE和EHE高于MHHs（分别为4.7%对3.9%和5.5%对4.6%），并且在有老年成员的FHHs中更高（分别为5.8%对4.9%和6.9%对5.8%）。有老年成员的FHHs中的EHE在地理上从3.9%到9.1%不等，在欠发达的东部、中北部和东南部各州更高。与MHHs相比，FHHs面临更大的CHE和EHE风险。由于性别交叉脆弱性，这种脆弱性在有老年成员的FHHs中更加严重。当前背景下，非传染性疾病负担日益加重，且COVID-19加剧了不平等，这使得多个可持续发展目标（SDGs）之间的关键相互联系变得明显，并呼吁采取紧急措施加强卫生领域的社会保护。
