Specialist in Community Medicine/ Professor in Public Health, Paraclinical Department Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.
Senior Lecturer, Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
BMC Health Serv Res. 2024 Sep 12;24(1):1055. doi: 10.1186/s12913-024-11553-4.
Healthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage.
We aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts.
A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05.
Common NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals.
Patients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications.
依赖自费支出（Out-of-Pocket Expenditure，OOPE）的医疗融资系统给经常使用服务的人（如慢性病患者）带来了沉重的负担。高额的医疗服务自费支出导致服务利用率下降和/或灾难性医疗支出，这将严重阻碍全民健康覆盖的实现。
我们旨在确定四个地区患有非传染性疾病（NCD）的家庭的自费支出（OOPE）变化情况以及与灾难性医疗支出（Catastrophic Health Expenditure，CHE）相关的因素。
对 2344 名患有选定 NCD/s 的成年患者进行了一项调查。多阶段分层聚类抽样从代表城市、农村、半城市和庄园的四个地区选择了受访者。使用经过验证的访谈者管理的问卷收集数据。逻辑回归确定了 CHE（>40%）的预测因素。显著性水平设为 0.05。
常见的 NCD 包括高血压（29.1%）、糖尿病（26.8.0%）、高血脂（9.8%）和哮喘（8.2%）。只有 13%的人报告了与 NCD 相关的并发症。56%（N=1304）定期在诊所随访，大多数人利用西医药政府医院（N=916，70.2%）。过去 12 个月内有 252 次因慢性疾病管理而住院。大多数（86%）住院于政府部门医院。大多数患者每次诊所就诊的费用约为 3000 斯里兰卡卢比，每次住院的费用约为 3300 斯里兰卡卢比。13.5%的住院和 6.1%的定期诊所随访的 CHE 超过 40%。私营部门医院收治的患者 CHE 是政府部门医院收治患者的 2.61 倍。
斯里兰卡的 NCD 患者在寻求医疗保健时自费支出高，并面临 CHE。参与者中 NCD 和并发症的患病率很高。患有慢性疾病的患者每次就诊和住院都要自费支出大量资金。患者自费支付直接医疗费用，并且在地区之间存在差异。每月诊所就诊 CHE 超过 40%的比例较高。在政府部门接受治疗的患者在获得医疗保健时更有可能面临 CHE，并且更有可能在获得所需医疗服务方面面临障碍。为慢性病患者提供的服务需要更综合的方法来减轻成本负担和相关并发症。
