{"title":"埃塞俄比亚西北部投保与未投保的灾难性医疗支出差异:多变量分解分析。","authors":"Yawkal Tsega, Gebeyehu Tsega, Asnakew Molla Mekonen, Tesfaye Birhane, Elsabeth Addisu, Abebe Getie, Fekade Demeke Bayou, Mulugeta Desalegn Kasaye, Natnael Kebede, Amare Muche","doi":"10.1186/s13561-024-00533-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Financial risk protection is one indicator of universal health coverage (UHC). All people should be protected from financial risks such as catastrophic health expenditures (CHE) to ensure equitable health services. Ethiopia has launched community-based health insurance (CBHI) since 2011 to protect people from financial risk. However, out-of-pocket health expenditure is a financial barriers to achieve UHC. The insured-non-insured disparity of CHE has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the disparity of CHE between insured and non-insured households and its contributing factors in Debre Tabor town.</p><p><strong>Methods: </strong>This study used the primary household survey data collected from May to June 2022 in Debre Tabor town. Data were collected from 825 household heads and analyzed using STATA version 17.0 statistical software. Logit-based multivariate decomposition analysis was conducted to determine insured-non-insured disparity of CHE. Statistical significance for all analysis was declared at a p < 0.05.</p><p><strong>Results: </strong>The incidence of CHE was 17.94% and 5.58% among non-insured and insured households, respectively. About 53% and 153.20% of the insured-non-insured disparities in the magnitude of CHE were due to the difference in characteristics (endowments) and the effect of characteristics (coefficients), respectively. Age of the household head between 46 and 60 years and above 60 years, divorced and widowed marital status of household head, and chronic health conditions were the explanatory variables widening the gap in the incidence of CHE. However, do not seeking traditional medicine, family size above 4, and age of household head between 31 and 45 years were the variables contribute in reducing the gap (i.e. due to endowments) in the incidence of CHE between insured and non-insured households. Moreover, the variables that contributed to the gap in the incidence of CHE due to covariate effects were age (31-45) and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines.</p><p><strong>Conclusion: </strong>This study revealed there is a significant disparity in the incidence of CHE between insured and non-insured households. Age, marital status and occupation of the household head, family size of household, presence of a chronically ill household member and seeking traditional medicine were significantly contributing factors for the disparity of CHE between insured and non-insured households due to endowments. The variables that contributed to the disparity in the incidence of CHE due to covariate effects were age and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines. Therefore, the policy makers need to emphasize in increasing the insurance coverage among households, and providing affordable health services in Ethiopia in general and Debre Tabor town in particular.</p>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253456/pdf/","citationCount":"0","resultStr":"{\"title\":\"Insured-non-insured disparity of catastrophic health expenditure in Northwest Ethiopia: a multivariate decomposition analysis.\",\"authors\":\"Yawkal Tsega, Gebeyehu Tsega, Asnakew Molla Mekonen, Tesfaye Birhane, Elsabeth Addisu, Abebe Getie, Fekade Demeke Bayou, Mulugeta Desalegn Kasaye, Natnael Kebede, Amare Muche\",\"doi\":\"10.1186/s13561-024-00533-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Financial risk protection is one indicator of universal health coverage (UHC). All people should be protected from financial risks such as catastrophic health expenditures (CHE) to ensure equitable health services. Ethiopia has launched community-based health insurance (CBHI) since 2011 to protect people from financial risk. However, out-of-pocket health expenditure is a financial barriers to achieve UHC. The insured-non-insured disparity of CHE has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the disparity of CHE between insured and non-insured households and its contributing factors in Debre Tabor town.</p><p><strong>Methods: </strong>This study used the primary household survey data collected from May to June 2022 in Debre Tabor town. Data were collected from 825 household heads and analyzed using STATA version 17.0 statistical software. Logit-based multivariate decomposition analysis was conducted to determine insured-non-insured disparity of CHE. Statistical significance for all analysis was declared at a p < 0.05.</p><p><strong>Results: </strong>The incidence of CHE was 17.94% and 5.58% among non-insured and insured households, respectively. About 53% and 153.20% of the insured-non-insured disparities in the magnitude of CHE were due to the difference in characteristics (endowments) and the effect of characteristics (coefficients), respectively. Age of the household head between 46 and 60 years and above 60 years, divorced and widowed marital status of household head, and chronic health conditions were the explanatory variables widening the gap in the incidence of CHE. However, do not seeking traditional medicine, family size above 4, and age of household head between 31 and 45 years were the variables contribute in reducing the gap (i.e. due to endowments) in the incidence of CHE between insured and non-insured households. Moreover, the variables that contributed to the gap in the incidence of CHE due to covariate effects were age (31-45) and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines.</p><p><strong>Conclusion: </strong>This study revealed there is a significant disparity in the incidence of CHE between insured and non-insured households. Age, marital status and occupation of the household head, family size of household, presence of a chronically ill household member and seeking traditional medicine were significantly contributing factors for the disparity of CHE between insured and non-insured households due to endowments. The variables that contributed to the disparity in the incidence of CHE due to covariate effects were age and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines. Therefore, the policy makers need to emphasize in increasing the insurance coverage among households, and providing affordable health services in Ethiopia in general and Debre Tabor town in particular.</p>\",\"PeriodicalId\":2,\"journal\":{\"name\":\"ACS Applied Bio Materials\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2024-07-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253456/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Bio Materials\",\"FirstCategoryId\":\"96\",\"ListUrlMain\":\"https://doi.org/10.1186/s13561-024-00533-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MATERIALS SCIENCE, BIOMATERIALS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Bio Materials","FirstCategoryId":"96","ListUrlMain":"https://doi.org/10.1186/s13561-024-00533-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MATERIALS SCIENCE, BIOMATERIALS","Score":null,"Total":0}
引用次数: 0
摘要
背景:财务风险保护是全民医保(UHC)的一项指标。所有人都应受到保护,免受灾难性医疗支出(CHE)等财务风险的影响,以确保公平的医疗服务。埃塞俄比亚自 2011 年起推出了社区医疗保险(CBHI),以保护人们免受财务风险。然而,自付医疗支出是实现全民医保的财务障碍。在埃塞俄比亚,尤其是在 Debre Tabor 镇,对自付医疗费用的投保与未投保差异尚未进行深入研究。因此,本研究旨在评估 Debre Tabor 镇投保家庭与未投保家庭之间的医疗费用差距及其诱因:本研究使用了 2022 年 5 月至 6 月在德布雷塔博尔镇收集的主要家庭调查数据。数据收集自 825 个户主,并使用 STATA 17.0 版统计软件进行分析。采用基于 Logit 的多元分解分析来确定 CHE 的投保-未投保差异。所有分析的统计显著性均以 p 表示:非投保家庭和投保家庭的 CHE 发生率分别为 17.94% 和 5.58%。投保家庭与未投保家庭在 CHE 发生率上的差异中,分别约有 53% 和 153.20% 是由特征(禀赋)差异和特征影响(系数)造成的。户主年龄在 46 至 60 岁之间和 60 岁以上、户主的离婚和丧偶婚姻状况以及慢性健康状况是拉大 CHE 发生率差距的解释变量。然而,不寻求传统医学、家庭人口在 4 人以上以及户主年龄在 31 至 45 岁之间的变量则有助于缩小投保家庭与非投保家庭之间的 CHE 发生率差距(即由于禀赋)。此外,由于协变量效应而导致 CHE 发生率差距的变量是户主的年龄(31-45 岁)和婚姻状况、财富状况、家庭规模、家庭所有权和寻求传统药物:本研究表明,投保家庭与未投保家庭的 CHE 发生率存在显著差异。年龄、户主的婚姻状况和职业、家庭规模、是否有长期患病的家庭成员以及是否寻求传统药物是造成投保家庭和非投保家庭之间因禀赋而导致的 CHE 发病率差异的重要因素。由于协变量效应而导致 CHE 发病率差异的变量是户主的年龄和婚姻状况、财富状况、家庭规模、家庭所有权和寻求传统药物。因此,政策制定者需要重视提高家庭保险覆盖率,并在埃塞俄比亚,特别是德布雷塔博镇,提供负担得起的医疗服务。
Insured-non-insured disparity of catastrophic health expenditure in Northwest Ethiopia: a multivariate decomposition analysis.
Background: Financial risk protection is one indicator of universal health coverage (UHC). All people should be protected from financial risks such as catastrophic health expenditures (CHE) to ensure equitable health services. Ethiopia has launched community-based health insurance (CBHI) since 2011 to protect people from financial risk. However, out-of-pocket health expenditure is a financial barriers to achieve UHC. The insured-non-insured disparity of CHE has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the disparity of CHE between insured and non-insured households and its contributing factors in Debre Tabor town.
Methods: This study used the primary household survey data collected from May to June 2022 in Debre Tabor town. Data were collected from 825 household heads and analyzed using STATA version 17.0 statistical software. Logit-based multivariate decomposition analysis was conducted to determine insured-non-insured disparity of CHE. Statistical significance for all analysis was declared at a p < 0.05.
Results: The incidence of CHE was 17.94% and 5.58% among non-insured and insured households, respectively. About 53% and 153.20% of the insured-non-insured disparities in the magnitude of CHE were due to the difference in characteristics (endowments) and the effect of characteristics (coefficients), respectively. Age of the household head between 46 and 60 years and above 60 years, divorced and widowed marital status of household head, and chronic health conditions were the explanatory variables widening the gap in the incidence of CHE. However, do not seeking traditional medicine, family size above 4, and age of household head between 31 and 45 years were the variables contribute in reducing the gap (i.e. due to endowments) in the incidence of CHE between insured and non-insured households. Moreover, the variables that contributed to the gap in the incidence of CHE due to covariate effects were age (31-45) and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines.
Conclusion: This study revealed there is a significant disparity in the incidence of CHE between insured and non-insured households. Age, marital status and occupation of the household head, family size of household, presence of a chronically ill household member and seeking traditional medicine were significantly contributing factors for the disparity of CHE between insured and non-insured households due to endowments. The variables that contributed to the disparity in the incidence of CHE due to covariate effects were age and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines. Therefore, the policy makers need to emphasize in increasing the insurance coverage among households, and providing affordable health services in Ethiopia in general and Debre Tabor town in particular.