Programa de Pós-Graduação em Economia, Universidade de Brasília, Brasília, Distrito Federal, Brazil.
Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil.
Public Health. 2024 Nov;236:175-183. doi: 10.1016/j.puhe.2024.08.001. Epub 2024 Sep 7.
Although catastrophic health spending is the main measure for assessing financial healthcare protection, it varies considerably in methodological and empirical terms, which hinders comparison between studies. The aim of this study was to measure the prevalence of catastrophic health spending in Brazil in 2003, 2009, and 2018, its associated factors, and disparities in prevalence distribution according to socioeconomic status.
This was a time series study.
Data from the Household Budget Surveys were used. Prevalence of catastrophic health spending was measured as a percentage of the budget and ability to pay, considering thresholds of 10, 25, and 40%. It was determined whether household, family, and household head characteristics influence the likelihood of incurring catastrophic health spending. Households were stratified by income deciles, consumption, and wealth score.
There was an increase in prevalence of catastrophic health spending between 2003 and 2009 in Brazil and a slight reduction in 2018. The wealth score showed more pronounced distributional effects between the poor and the rich, with the former being the most affected by catastrophic health spending. Consumption showed greater percentage variations in the prevalence of catastrophic health spending. The prevalence of catastrophic health spending was positively associated with the presence of older adults, age and female household head, rural area, receipt of government benefits, and some degree of food insecurity.
The poorest families are most affected by catastrophic health spending in Brazil, requiring more effective and equitable policies to mitigate financial risk.
尽管灾难性卫生支出是评估医疗保健财务保障的主要指标，但在方法和实证方面存在很大差异，这阻碍了研究之间的比较。本研究旨在衡量 2003 年、2009 年和 2018 年巴西灾难性卫生支出的流行率、其相关因素以及根据社会经济地位分布的差异。
这是一项时间序列研究。
使用家庭预算调查数据。灾难性卫生支出的流行率以预算和支付能力的百分比来衡量，考虑了 10%、25%和 40%的阈值。确定家庭、家庭和家庭负责人的特征是否影响发生灾难性卫生支出的可能性。根据收入十分位数、消费和财富评分对家庭进行分层。
2003 年至 2009 年巴西灾难性卫生支出的流行率有所增加，2018 年略有下降。财富评分在贫富之间显示出更明显的分布效应，前者受灾难性卫生支出的影响最大。消费在灾难性卫生支出的流行率方面显示出更大的百分比变化。灾难性卫生支出的流行率与老年人、家庭负责人年龄和性别、农村地区、获得政府福利以及某种程度的粮食不安全状况呈正相关。
巴西最贫困的家庭受灾难性卫生支出的影响最大，需要采取更有效和公平的政策来减轻财务风险。
