Economics Discipline, Khulna University, Khulna, Bangladesh.
BMC Public Health. 2024 Jun 5;24(1):1504. doi: 10.1186/s12889-024-18579-7.
Out-of-pocket (OOP) payment is one of many countries' main financing options for health care. High OOP payments push them into financial catastrophe and the resultant impoverishment. The infrastructure, society, culture, economic condition, political structure, and every element of the physical and social environment influence the intensity of financial catastrophes in health expenditure. Hence, the incidence of Catastrophic Health Expenditure (CHE) must be studied more intensively, specifically from regional aspects. This systematic review aims to make a socio-ecological synthesis of the predictors of CHE.
We retrieved data from Scopus and Web of Science. This review followed PRISMA guidelines. The interest outcomes of the included literature were the incidence and the determinants of CHE. This review analyzed the predictors in light of the socio-ecological model.
Out of 1436 screened documents, fifty-one met the inclusion criteria. The selected studies were quantitative. The studies analyzed the socioeconomic determinants from the demand side, primarily focused on general health care, while few were disease-specific and focused on utilized care. The included studies analyzed the interpersonal, relational, and institutional predictors more intensively. In contrast, the community and policy-level predictors are scarce. Moreover, neither of the studies analyzed the supply-side predictors. Each CHE incidence has different reasons and different outcomes. We must go with those case-specific studies. Without the supply-side response, it is difficult to find any effective solution to combat CHE.
Financial protection against CHE is one of the targets of sustainable development goal 3 and a tool to achieve universal health coverage. Each country has to formulate its policy and enact laws that consider its requirements to preserve health rights. That is why the community and policy-level predictors must be studied more intensively. Proper screening of the cause of CHE, especially from the perspective of the health care provider's perspective is required to identify the individual, organizational, community, and policy-level barriers in healthcare delivery.
自付（OOP）支付是许多国家医疗保健的主要融资选择之一。高额的自付费用使他们陷入财务灾难和由此导致的贫困。基础设施、社会、文化、经济状况、政治结构以及物理和社会环境的每一个要素都影响着卫生支出中财务灾难的严重程度。因此，必须更深入地研究灾难性卫生支出（CHE）的发生，特别是从区域角度进行研究。本系统评价旨在对 CHE 的预测因素进行社会生态学综合分析。
我们从 Scopus 和 Web of Science 检索数据。本综述遵循 PRISMA 指南。纳入文献的感兴趣结果是 CHE 的发生率和决定因素。本综述根据社会生态学模型分析了预测因素。
在筛选出的 1436 篇文献中，有 51 篇符合纳入标准。所选研究为定量研究。这些研究从需求侧分析了社会经济决定因素，主要集中在一般医疗保健上，而少数研究是针对特定疾病并侧重于利用医疗保健。纳入的研究更深入地分析了人际、关系和制度预测因素。相比之下，社区和政策层面的预测因素较少。此外，没有研究分析供应侧预测因素。每次 CHE 发生率都有不同的原因和不同的结果。我们必须结合具体情况进行研究。没有供应侧的反应，就很难找到任何有效的方法来对抗 CHE。
防范 CHE 的财务风险是可持续发展目标 3 的目标之一，也是实现全民健康覆盖的工具。每个国家都必须制定政策和立法，考虑其维护健康权利的要求。这就是为什么必须更深入地研究社区和政策层面的预测因素。需要对 CHE 的原因进行适当的筛查，特别是从医疗保健提供者的角度，以确定医疗服务提供中存在的个人、组织、社区和政策层面的障碍。
