Protecting households from catastrophic health spending

Many countries rely heavily on patients' out-of-pocket payments to providers to finance their health care systems. This prevents some people from seeking care and results in financial catastrophe and impoverishment for others who do obtain care. Surveys in eighty-nine countries covering 89 percent of the world's population suggest that 150 million people globally suffer financial catastrophe annually because they pay for health services. Prepayment mechanisms protect people from financial catastrophe, but there is no strong evidence that social health insurance systems offer better or worse protection than tax-based systems do.     

安徽省农村居民灾难性卫生支出状况分析

目的：研究安徽省农村居民家庭灾难性卫生支出概况。方法：分析2009年安徽省样本地区新农合补偿前后居民家庭灾难性卫生支出发生率、灾难性卫生支出差距以及灾难性卫生支出集中指数的变化情况。结果：新农合补偿以后,样本地区灾难性卫生支出发生率、平均差距和相对差距均有所下降,而且灾难性卫生支出差距集中指数进一步向0靠近,提示平均差距在补偿后则进一步趋向平衡。结论：安徽省农村家庭现金卫生支出负担相对较重;灾难性卫生支出有从贫困家庭扩大到相对富裕家庭的趋势;新农合补偿降低了灾难性卫生支出的发生,但从整体上看作用有限。     

Examining the density in out-of-pocket spending share in the estimation of catastrophic health expenditures

The European Journal of Health Economics - Universal health coverage (UHC) aims to provide access to health services for all without financial hardship. Moving toward UHC while ensuring financial...     

Prevalence of lifetime abortion and methods of contraception among female sex workers in Bogota, Colombia

BACKGROUND: The primary objective was to estimate the lifetime prevalence of abortion and the secondary objective was to describe the use of contraceptive methods among female sex workers (FSW) in Bogota, Colombia. STUDY DESIGN: A cross-sectional survey was conducted among FSW. Information on sociodemographic characteristics, contraceptive methods, number of abortions, reasons for abortions and sexual practices was collected. RESULTS: A total of 514 FSW were enrolled. Of these, 264 (53%) had a lifetime abortion. Age, years in sex work and a previous sexually transmitted infection were associated with abortion. A total of 89 FSW(17%) reported no contraception method. Oral contraceptives, use of condoms, female sterilization and intrauterine device insertion were the most common methods of contraception. Women who were poorer, who initiated sex work at a younger age and who reported use of illegal drugs were associated with inconsistent contraception. CONCLUSION: A high lifetime prevalence of abortion and inconsistent contraception was found among FSW in Bogota. There is a need for effective and practical contraceptive methods of family health planning among FSW in Colombia.     

间接医疗费用对造成家庭重大医疗支出的影响

目的研究间接医疗费用对增加家庭医疗费用负担以及引起家庭重大医疗支出的作用及其影响因素。方法利用2003年全国卫生服务调查资料,定量测算门诊及住院间接医疗费用及其造成的家庭重大医疗支出发生率,并利用回归模型分析其影响因素。结果间接医疗费用在门诊和住院中都非常普遍,间接医疗费用可以直接导致1％-2％的家庭重大医疗支出发生,特别是在农村地区作用更为明显。影响间接医疗费用的主要因素包括收入状况、保险类型,及家庭与卫生机构的距离。结论间接医疗费用不但可以增加家庭的医疗支出,而且可以直接造成家庭重大医疗支出的发生,特别是对于农村地区和弱势人群的作用更加突出。为了更好的解决“看病难”问题,要对间接医疗费用引起足够的重视,并通过提高卫生服务利用的物理可及性和经济可及性、扩大医疗保障覆盖范围和覆盖力度来加以解决,同时还要特别关注弱势群体和农村地区。     

Armed conflict,health spending,and HIV

Among current studies, there is still question as to whether conflict increases, decreases, or has no effect on HIV prevalence. This lack of clarity can be attributed to the scarcity of quantitative analysis in this field. Thus, studies about conflict and HIV have failed to specify the ways conflict affects HIV prevalence, if indeed it does. In this paper, I argue that armed conflict increases HIV prevalence by reducing total per capita health spending. Using HIV prevalence data from 1990 to 2009, I find supporting evidence in the case of civil conflicts for these arguments. In addition, I find that as the severity of civil conflict increases, so do HIV rates. These findings have significant policy implications for individual governments, as well as for the international community.     

大理州巍山县农村家庭发生灾难性卫生支出的影响因素研究

[目的]探索影响大理州巍山县农村居民家庭发生灾难性支出的主要因素。[方法]计算WHO在2000年世界卫生报告中所介绍的卫生筹资贡献率(HFC),按照该值是否大于等于40%的标准将随机抽取的家庭分为两类,采用logistic回归分析影响家庭发生灾难性支出的主要因素。[结果]大理州巍山县农村发生灾难性卫生支出的家庭比例为11.19%,影响家庭灾难性卫生支出的因素有:家庭年收入、家庭中是否有人住院。[结论]家庭年收入、家庭中是否有人住院等因素会影响大理巍山县农村家庭灾难性卫生支出的发生。     

Evaluation of effects of the health subsidy focalization policy on the population lacking payment capacity from our localities in Bogota, D.C., Colombia, 2001

OBJECTIVES: To analyze the problems of the focalization policy and the characteristics of decision-making to assign health subsidies for the population of Sisben levels 3 and 4 of 4 localities in Bogotá, in order to propose criteria for transforming the processes of policy formulation and correct its defects on marginalization and exclusion. METHODS: A critical, participative and pluralist methodological approach, which combined multiple research methods and techniques from a systemic and post-estructuralist perspective, was undertaken. For sub-projects were carried out. The subsidy-focalization policy in Colombia was analyzed based upon the arguments of the main socio-political actors who participated in its formulation. In order to establish how the focalization policy of health spending is perceived by the excluded population, the public providers and the local authorities, a qualitative study was done based upon focal groups and in-depth interviews. A follow-up of the accessibility to and use of health services was also carried out from the definition of a tracing condition. Finally, collective recommendations of policies were formulated from the per     

HIV knowledge and risk behaviors among women in law enforcement in Bogota,Colombia: Potential role as community Educators

As HIV infection is increasing among women, evaluation, prevention, and education campaigns need to target this vulnerable population, Because of their frequent and accepted contact with members of the community, female law officers, if knowledgeable, could be well suited to provide information/education related to HIV/STD transmission. A survey of HIV/AIDS knowledge and risk behaviors was administered to 120 law enforcement women (LEW) and 60 women from the general population (GPW) in Bogotá, Colombia. LEW indicated a very high (90%) understanding of basic HIV knowledge. Although most (52%) of the LEW did not report high-risk behaviors, 29% indicated having unprotected sex during menses, and 17% had unprotected anal sex. This contrasts, however, with GPW, who were of similar age, but had a significantly higher prevalence (73%) of risky behaviors (P=.004). Moreover, 52% of the GPW reported having unprotected anal sex, and approximately half of this group (55%) indicated having unprotected sex during menses. Alcohol and drug users were also more prevalent in the GPW: 14% frequently used alcohol and 3% inhaled drugs during sexual encounters, contrasted to 2% of LEW reporting alcohol use. GPW were four times more likely than LEW, to engage in high-risk sexual practices [95% confidence interval (CI)=1.9–10.4, P=0.034]. Multivariate analyses indicated that alcohol and/or drug use were significantly associated with high-risk sexual practices [odds ratio (OR)=4.7, 95% confidence intervals (CI)=1.3–18.4, P=.02). Improved educational HIV/AIDS programs are needed, particularly for women in the general population, who use alcohol/drugs during sexual encounters, which account, at least in part, for their high-risk behaviors. Women in law enforcement, who appear knowledgeable and exhibit safer behaviors, could be useful educators for GPW. Because of their professional role in the community, training for LEW in HIV/AIDS education/prevention programs should be considered.     

Determinants of catastrophic health expenditure in Nigeria

Background

Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria.

Methods

Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression.

Results

Results showed that irrespective of the threshold for the two concepts of total household expenditure and non-food expenditure, having household members aged between 6 and 14 years, having household members aged between 15 and 24 years, having household members aged between 25 and 54 years, having no education, having primary education, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households.

Conclusions

Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy.