Tambor Marzena, García-Ramírez Jorge Alejandro, Pavlova Milena
Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawinska Street, 31-008 Krakow, Poland.
WHO Barcelona Office for Health Systems Financing, Sant Pau Art Nouveau Site (La Mercè), 08025 Barcelona, Spain.
Health Policy Open. 2025 Jun 7;9:100143. doi: 10.1016/j.hpopen.2025.100143. eCollection 2025 Nov.
Protecting households from financial hardship when accessing health care is a universal policy objective across European countries. Previous analyses have shown that households in Poland relatively often experience financial strain due to out-of-pocket payments for health. This study aims to provide new evidence on financial protection in Poland, using indicators of catastrophic and impoverishing health spending. We used data from annual household budget surveys between 2013 and 2021. Catastrophic spending is defined as payments for health greater than 40% of the household's capacity to pay, while impoverishing spending occurs when out-of-pocket payments are higher than the capacity to pay. We employed logistic regression to identify factors associated with catastrophic payments. The incidence of catastrophic spending was 9% in 2021 and remained relatively constant over the years analyzed, nearing 10% only in 2020. Further, 3.3% of households in 2021 were impoverished or further impoverished, down from 4.1% in 2013. Payments for medicines contribute the most to catastrophic spending, but the role of other services has been increasing. We found a significant association between catastrophic payments and gender, age, education, disability, residence place, number of children, main source of income, and consumption level. It is necessary to address existing coverage gaps and to evaluate implemented policies in order to develop more effective measures to reduce the burden of out-of-pocket payments in Poland.
在欧洲各国，保护家庭在获得医疗保健时免受经济困难影响是一项普遍的政策目标。先前的分析表明，波兰家庭因自付医疗费用而相对频繁地面临经济压力。本研究旨在利用灾难性和致贫性医疗支出指标，为波兰的经济保护提供新的证据。我们使用了2013年至2021年年度家庭预算调查的数据。灾难性支出定义为医疗支出超过家庭支付能力的40%，而当自付费用高于支付能力时就会出现致贫性支出。我们采用逻辑回归来确定与灾难性支付相关的因素。2021年灾难性支出的发生率为9%，在分析的这些年里相对保持稳定，仅在2020年接近10%。此外，2021年3.3%的家庭陷入贫困或进一步贫困，低于2013年的4.1%。药品支出对灾难性支出的贡献最大，但其他服务的作用一直在增加。我们发现灾难性支付与性别、年龄、教育程度、残疾状况、居住地点、子女数量、主要收入来源和消费水平之间存在显著关联。有必要解决现有的覆盖缺口并评估已实施的政策，以便制定更有效的措施来减轻波兰自付费用的负担。
