{"title":"人口老龄化背景下的全民医保:灾难性医疗支出和未满足的医疗需求。","authors":"Shohei Okamoto, Mizuki Sata, Megumi Rosenberg, Natsuko Nakagoshi, Kazuki Kamimura, Kohei Komamura, Erika Kobayashi, Junko Sano, Yuzuki Hirazawa, Tomonori Okamura, Hiroyasu Iso","doi":"10.1186/s13561-023-00475-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤).</p><p><strong>Methods: </strong>Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members' age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age.</p><p><strong>Results: </strong>Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need.</p><p><strong>Conclusions: </strong>Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"8"},"PeriodicalIF":2.7000,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10826197/pdf/","citationCount":"0","resultStr":"{\"title\":\"Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare.\",\"authors\":\"Shohei Okamoto, Mizuki Sata, Megumi Rosenberg, Natsuko Nakagoshi, Kazuki Kamimura, Kohei Komamura, Erika Kobayashi, Junko Sano, Yuzuki Hirazawa, Tomonori Okamura, Hiroyasu Iso\",\"doi\":\"10.1186/s13561-023-00475-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤).</p><p><strong>Methods: </strong>Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members' age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age.</p><p><strong>Results: </strong>Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need.</p><p><strong>Conclusions: </strong>Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.</p>\",\"PeriodicalId\":46936,\"journal\":{\"name\":\"Health Economics Review\",\"volume\":\"14 1\",\"pages\":\"8\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-01-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10826197/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health Economics Review\",\"FirstCategoryId\":\"96\",\"ListUrlMain\":\"https://doi.org/10.1186/s13561-023-00475-2\",\"RegionNum\":3,\"RegionCategory\":\"经济学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ECONOMICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Economics Review","FirstCategoryId":"96","ListUrlMain":"https://doi.org/10.1186/s13561-023-00475-2","RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ECONOMICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:全民医保意味着所有人都能获得基本医疗服务,而不会陷入经济困境。即使在服务覆盖面广、财政保障完善的国家,由于老年人口不断增加,实现全民医保的进程可能会放缓或受到限制。本研究调查了灾难性医疗支出(CHE)和未满足的医疗需求的发生率/流行率、决定因素和后果,并评估了年轻人(≤64 岁)和老年人(65 岁以下)之间的潜在异质性:通过对 20 岁及以上日本人进行的年度全国代表性调查,我们使用按家庭成员年龄(即≤64 岁与 65 岁≤)分列的估算值估算了 2004 年至 2020 年期间 CHE 的发病率和未满足的医疗保健需求。利用固定效应模型,我们评估了健康和营养状况及未满足需求的决定因素,以及健康和营养状况的后果。我们还评估了不同年龄的异质性:有老年成员的家庭更有可能使其医疗保健需求得到满足,但与没有老年成员的家庭相比,他们的医疗保健需求得到满足的可能性更大。CHE的经济后果因年龄而异,这表明有老年成员的家庭通过减少食品和社会支出来应对CHE,比没有老年成员的家庭减少教育支出的程度更高。没有老年成员的家庭在发生 "家庭健康状况调查 "后的一年中收入下降,而有老年成员的家庭则没有出现这种情况。年龄与医疗需求得不到满足的概率呈 U 型关系:结论:与有年轻成员的家庭相比,有年长成员的家庭更有可能经历不同经济后果的健康问题。与中年成员相比,年轻和年长成员的医疗保健需求未得到满足的情况更为普遍。需要在国家卫生系统和社会保障政策中纳入不同类型和水平的医疗和财务支持,以满足个人和家庭的独特需求。
Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare.
Background: Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤).
Methods: Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members' age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age.
Results: Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need.
Conclusions: Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.
期刊介绍:
Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.