评估卫生领域的财务保护:突尼斯的案例。

Mohammad Abu-Zaineh, Habiba Ben Romdhane, Bruno Ventelou, Jean-Paul Moatti, Arfa Chokri
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引用次数: 30

摘要

尽管在扩大卫生领域社会保护机制的覆盖面方面取得了显著进展,但突尼斯卫生保健系统的资金主要仍然来自直接自付。本文试图利用关于保健支出、利用和发病率的具有全国代表性的调查数据,评估突尼斯在特定政策和流行病学转型中保健方面的财务保护。医疗保健系统在多大程度上保护人们免受健康不良的财务影响,使用灾难性和贫困化支付方法进行评估。使用多变量逻辑回归技术检查了与易受灾难性卫生支出(CHE)影响的可能性相关的特征。结果显示,突尼斯人口中不可忽略的比例(从可自由支配的非食品支出40%的保守阈值4.5%到总支出10%的阈值12%)发生了CHE。在贫困化方面,结果表明,卫生支出可导致约18%的贫困差距扩大。与其他发展水平相似的国家相比,这些结果似乎相对较高。尽管如此,尽管属于较富裕五分之一的家庭比贫困家庭报告了更多的疾病发作和接受了更多的治疗,但后者的家庭更有可能在任何阈值下发生CHE。在CHE的相关因素中,无论使用何种阈值,健康保险覆盖率都与CHE显著相关。提出了一些可能对其他类似国家也有用的影响和政策建议,以增强突尼斯医疗保健系统的财务保护能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Appraising financial protection in health: the case of Tunisia.

Despite the remarkable progress in expanding the coverage of social protection mechanisms in health, the Tunisian healthcare system is still largely funded through direct out-of-pocket payments. This paper seeks to assess financial protection in health in the particular policy and epidemiological transition of Tunisia using nationally representative survey data on healthcare expenditure, utilization and morbidity. The extent to which the healthcare system protects people against the financial repercussions of ill-health is assessed using the catastrophic and impoverishing payment approaches. The characteristics associated with the likelihood of vulnerability to catastrophic health expenditure (CHE) are examined using multivariate logistic regression technique. Results revealed that non-negligible proportions of the Tunisian population (ranging from 4.5 % at the conservative 40 % threshold of discretionary nonfood expenditure to 12 % at the 10 % threshold of total expenditure) incurred CHE. In terms of impoverishment, results showed that health expenditure can be held responsible for about 18 % of the rise in the poverty gap. These results appeared to be relatively higher when compared with those obtained for other countries with similar level of development. Nonetheless, although households belonging to richer quintiles reported more illness episodes and received more treatment than the poor households, the latter households were more likely to incur CHE at any threshold. Amongst the correlates of CHE, health insurance coverage was significantly related to CHE regardless of the threshold used. Some implications and policy recommendations, which might also be useful for other similar countries, are advanced to enhance the financial protection capacity of the Tunisian healthcare system.

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