Institute of Health and Society, University of Oslo, P.O. Box 0315, Oslo, Norway.
School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania.
BMC Public Health. 2023 Aug 17;23(1):1567. doi: 10.1186/s12889-023-16509-7.
Over 150 million people, mostly from low and middle-income countries (LMICs) suffer from catastrophic health expenditure (CHE) every year because of high out-of-pocket (OOP) payments. In Tanzania, OOP payments account for about a quarter of the total health expenditure. This paper compares healthcare utilization and the incidence of CHE among improved Community Health Fund (iCHF) members and non-members in central Tanzania.
A survey was conducted in 722 households in Bahi and Chamwino districts in Dodoma region. CHE was defined as a household health expenditure exceeding 40% of total non-food expenditure (capacity to pay). Concentration index (CI) and logistic regression were used to assess the socioeconomic inequalities in the distribution of healthcare utilization and the association between CHE and iCHF enrollment status, respectively.
50% of the members and 29% of the non-members utilized outpatient care in the previous month, while 19% (members) and 15% (non-members) utilized inpatient care in the previous twelve months. The degree of inequality for utilization of inpatient care was higher (insured, CI = 0.38; noninsured CI = 0.29) than for outpatient care (insured, CI = 0.09; noninsured CI = 0.16). Overall, 15% of the households experienced CHE, however, when disaggregated by enrollment status, the incidence of CHE was 13% and 15% among members and non-members, respectively. The odds of iCHF-members incurring CHE were 0.4 times less compared to non-members (OR = 0.41, 95%CI: 0.27-0.63). The key determinants of CHE were iCHF enrollment status, health status, socioeconomic status, chronic illness, and the utilization of inpatient and outpatient care.
The utilization of healthcare services was higher while the incidence of CHE was lower among households enrolled in the iCHF insurance scheme relative to those not enrolled. More studies are needed to establish the reasons for the relatively high incidence of CHE among iCHF members and the low degree of healthcare utilization among households with low socioeconomic status.
每年有超过 1.5 亿人，主要来自中低收入国家（LMICs），由于高额自付费用（OOP）而遭受灾难性的医疗支出（CHE）。在坦桑尼亚，OOP 支出约占总卫生支出的四分之一。本文比较了中央坦桑尼亚改进社区健康基金（iCHF）成员和非成员的医疗保健利用情况和 CHE 发生率。
在多多马地区巴希和查姆维诺区的 722 户家庭中进行了一项调查。CHE 被定义为家庭卫生支出超过非食品总支出的 40%（支付能力）。集中指数（CI）和逻辑回归分别用于评估医疗保健利用的社会经济不平等程度以及 CHE 与 iCHF 参保状态之间的关联。
50%的成员和 29%的非成员在上个月利用了门诊服务，而 19%（成员）和 15%（非成员）在上一年中利用了住院服务。利用住院服务的不平等程度较高（参保，CI=0.38；未参保，CI=0.29），而门诊服务的不平等程度较低（参保，CI=0.09；未参保，CI=0.16）。总体而言，有 15%的家庭经历了 CHE，但按参保状态细分时，成员和非成员的 CHE 发生率分别为 13%和 15%。与非成员相比，iCHF 成员发生 CHE 的几率降低了 0.4 倍（OR=0.41，95%CI：0.27-0.63）。CHE 的主要决定因素是 iCHF 参保状态、健康状况、社会经济地位、慢性病以及住院和门诊服务的利用情况。
与未参保的家庭相比，参加 iCHF 保险计划的家庭的医疗服务利用率较高，而 CHE 的发生率较低。需要更多的研究来确定 iCHF 成员 CHE 发生率相对较高和社会经济地位较低的家庭医疗保健利用率较低的原因。
