Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile.
BMC Public Health. 2023 Apr 21;23(1):735. doi: 10.1186/s12889-023-15671-2.
This study examines the relationship between universal health coverage (UHC) and the burden of emergency diseases at a global level.
Data on Disability-Adjusted Life Years (DALYs) from emergency conditions were extracted from the Institute for Health Metrics and Evaluation (IHME) database for the years 2015 and 2019. Data on UHC, measured using two variables 1) coverage of essential health services and 2) proportion of the population spending more than 10% of household income on out-of-pocket health care expenditure, were extracted from the World Bank Database for years preceding our outcome of interest. A linear regression was used to analyze the association between UHC variables and DALYs for emergency diseases, controlling for other variables.
A total of 132 countries were included. The median national coverage of essential health services index was 67.5/100, while the median national prevalence of catastrophic spending in the sample was 6.74% of households. There was a strong significant relationship between health service coverage and the burden of emergency diseases, with an 11.5-point reduction in DALYs of emergency medical diseases (95% CI -9.5, -14.8) for every point increase in the coverage of essential health services index. There was no statistically significant relationship between catastrophic expenditures and the burden of emergency diseases, which may be indicative of inelastic demand in seeking services for health emergencies.
Increasing the coverage of essential health services, as measured by the essential health services index, is strongly correlated with a reduction in the burden of emergency conditions. In addition, data affirms that financial protection remains inadequate in many parts of the globe, with large numbers of households experiencing significant economic duress related to seeking healthcare. This evidence supports a strategy of strengthening UHC as a means of combating death and disability from health emergencies, as well as extending protection against impoverishment related to healthcare expenses.
本研究在全球范围内考察了全民健康覆盖（UHC）与急诊疾病负担之间的关系。
从卫生计量与评估研究所（IHME）数据库中提取了 2015 年和 2019 年与急诊情况相关的残疾调整生命年（DALYs）数据。使用两个变量 1）基本卫生服务覆盖和 2）超过 10%的家庭收入用于自付医疗保健支出的人口比例，从世界银行数据库中提取 UHC 数据，数据来自我们感兴趣的结果之前的年份。采用线性回归分析 UHC 变量与急诊疾病 DALYs 之间的关系，同时控制其他变量。
共纳入 132 个国家。基本卫生服务覆盖指数的全国中位数为 67.5/100，而样本中灾难性支出的全国中位数为 6.74%的家庭。卫生服务覆盖与急诊疾病负担之间存在显著的强相关性，基本卫生服务覆盖指数每增加一个点，急诊医疗疾病的 DALYs 减少 11.5 个点（95%CI-9.5，-14.8）。灾难性支出与急诊疾病负担之间无统计学显著关系，这可能表明对急诊卫生服务的需求缺乏弹性。
基本卫生服务覆盖指数衡量的基本卫生服务覆盖增加与急诊情况负担的降低密切相关。此外，数据证实，全球许多地区的财务保障仍然不足，大量家庭因寻求医疗保健而面临巨大的经济压力。这一证据支持加强 UHC 作为应对急诊死亡和残疾的战略，以及扩大对医疗费用相关贫困的保护。
