Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
Department of Health Policy, London School of Economics and Political Science, London, UK.
BMC Health Serv Res. 2024 Oct 12;24(1):1225. doi: 10.1186/s12913-024-11636-2.
Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia's health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors' knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.
哥伦比亚是世界上个人医疗支出财务保障最健全的国家之一，其自付支出在经合组织国家中排名最低。我们调查了 2013 年至 2021 年期间哥伦比亚医疗体系的 1900 多万用户（缴费计划）的年龄组、性别、医疗保健环境、健康状况和地理区域的健康支出的演变、分布和持续性。我们使用了卫生部和社会保障部促进健康实体的平均患者支出数据。我们应用了多元统计技术，如多元对应分析、因子图和相关性。对于男性和女性来说，平均医疗支出随年龄增长逐渐增加，直到 60 岁，此后迅速加速。支出占比最高的健康状况是与肿瘤、血液疾病、循环系统、妊娠、产褥期和围产期相关的疾病。我们发现，亚马逊-奥里诺科地区的家庭护理几乎不存在，与其他地区相比，所有年龄段的门诊护理比例都很高（超过 65%）。支出在下一年具有很强的持续性（即它们可以为预测提供相关信息），特别是在拥有更多医疗服务供应的地区，如波哥大-昆迪纳马卡。据作者所知，这是迄今为止为拉丁美洲国家制定的最全面和详细的健康支出微观分析。
