Abstract

This paper provides an overview of research on out-of-pocket health expenditures by reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of GDP spent on health. The two measures of dispersion or risk—the coefficient of variation and Q90/Q50—are only weakly correlated across countries and not explained by our macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of “catastrophic expenditures”. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.

中文翻译：

---

卫生方面的自付费用：全球盘点

摘要

本文通过回顾各种总结性措施以及使用这些措施进行的多国研究的结果，概述了自付费用卫生支出的研究。本文介绍了世界银行所有收入组对146个国家的所有汇总衡量指标的估算，以及汇总指标与宏观经济和卫生系统指标之间的相关性。各国之间在2011年国际美元的人均自付费用上出现了巨大差异，这在很大程度上是由于人均收入和医疗卫生支出占GDP份额的差异所致。分散性或风险这两个衡量指标（变异系数和Q90 / Q50）在各个国家之间的相关性很弱，我们的宏观经济和卫生系统指标并未对此进行解释。自付费用的卫生支出预算份额出现了很大的差异，这与“灾难性支出”的发生率高度相关。当对支出进行相对于收入的评估时，自付费用倾向于回归，而灾难性支出倾向于集中在穷人中；而当相对于收入进行评估时，支出倾向于渐进性，灾难性支出倾向于集中在富人中消费。在每天1.90美元的极端贫困线下，由于自费支出而导致的大多数贫困发生在低收入国家。当对支出进行相对于收入的评估时，自付费用倾向于回归，而灾难性支出倾向于集中在穷人中；而当相对于收入进行评估时，支出倾向于渐进性，灾难性支出倾向于集中在富人中消费。在每天1.90美元的极端贫困线下，由于自费支出而导致的大多数贫困发生在低收入国家。当对支出进行相对于收入的评估时，自付费用倾向于回归，而灾难性支出倾向于集中在穷人中；而当相对于收入进行评估时，支出倾向于渐进性，灾难性支出倾向于集中在富人中消费。在每天1.90美元的极端贫困线下，由于自费支出而导致的大多数贫困发生在低收入国家。