Socioeconomic Inequalities in Out-of-Pocket and Catastrophic Health Expenditures in Pakistan.

IF 2.6 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
International Journal of Public Health Pub Date : 2024-11-12 eCollection Date: 2024-01-01 DOI:10.3389/ijph.2024.1607313
Saima Bashir, Shabana Kishwar, Muhammad Nasir, Shehzad Ali
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引用次数: 0

Abstract

Objectives: In Pakistan, healthcare utilization is linked to out-of-pocket payments (OOP) which disproportionately affect low-income households. We investigated socioeconomic inequality in OOP and catastrophic health expenditures (CHEs), and the contribution of sociodemographic factors to these inequalities.

Methods: Socioeconomic inequalities were quantified using the concentration index (CI), and the slope (SII) and relative (RII) indices of inequality using data from three rounds of Household Integrated Economic Survey (2007-08, 2011-12, and 2018-19). Decomposition analyses were conducted using the Wagstaff and Erreygers approach.

Results: OOP payments increased from PKR 127 (2007-08) to PKR 250 (2018-19). CHEs in the most deprived quintile (Q1) changed from 8.3% (2007-08) to 13.7% (2018-19), and for the least deprived quintile (Q5) from 5.1% (2007-08) to 8.4% (2018-19). The OOP CI increased from 0.028 to 0.051, while the SII and RII increased from 0.89 to 1.32 and 1.18 to 1.36, respectively. Decomposition analysis showed that household size, composition, employment, and the province of residence explained much of the socioeconomic inequality in CHEs.

Conclusion: Poor households experience high CHE, disproportionately impacting larger families with children and elderly members. Policymakers should implement targeted financial protection strategies to safeguard vulnerable households from the impoverishing effects of healthcare expenses.

巴基斯坦自费和灾难性医疗支出中的社会经济不平等。
目的:在巴基斯坦,医疗保健的使用与自付费用(OOP)相关,而自付费用对低收入家庭的影响尤为严重。我们调查了自付费用和灾难性医疗支出(CHE)中的社会经济不平等现象,以及社会人口因素对这些不平等现象的影响:利用三轮家庭综合经济调查(2007-08 年、2011-12 年和 2018-19 年)的数据,使用集中指数(CI)、不平等斜率指数(SII)和相对指数(RII)对社会经济不平等进行量化。使用 Wagstaff 和 Erreygers 方法进行了分解分析:自费项目付款从 127 卢比(2007-08 年)增加到 250 卢比(2018-19 年)。最贫困的五分之一人口(Q1)的CHE从8.3%(2007-08年)变为13.7%(2018-19年),最不贫困的五分之一人口(Q5)的CHE从5.1%(2007-08年)变为8.4%(2018-19年)。OOP CI 从 0.028 增加到 0.051,而 SII 和 RII 分别从 0.89 增加到 1.32 和 1.18 增加到 1.36。分解分析表明,家庭规模、组成、就业和居住省份在很大程度上解释了社会经济不平等的原因:结论:贫困家庭的低保率很高,对有孩子和老人的大家庭影响更大。政策制定者应实施有针对性的财务保护战略,以保护弱势家庭免受医疗费用造成的贫困影响。
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来源期刊
International Journal of Public Health
International Journal of Public Health 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.20
自引率
2.20%
发文量
269
审稿时长
12 months
期刊介绍: The International Journal of Public Health publishes scientific articles relevant to global public health, from different countries and cultures, and assembles them into issues that raise awareness and understanding of public health problems and solutions. The Journal welcomes submissions of original research, critical and relevant reviews, methodological papers and manuscripts that emphasize theoretical content. IJPH sometimes publishes commentaries and opinions. Special issues highlight key areas of current research. The Editorial Board''s mission is to provide a thoughtful forum for contemporary issues and challenges in global public health research and practice.
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