ABSTRACT

Reducing Out-of-pocket (OOP) health payments is an essential element to protect households from financial risks and eradicate extreme poverty. This paper aimed to provide a new approach for measuring catastrophic health expenditure (CHE) by redefining subsistence spending to comprise the minimum acceptable level of all necessities. The new approach defined OOP health expenditures as catastrophic payments if they undermine a household’s ability to maintain essential needs that are not limited to food needs as assumed by the Capacity to pay (CTP) approach. The equivalence scale is estimated to reflect the dominant consumption patterns and the Cost of Basic Need Approach (CBN) is employed to measure the subsistence spending. We estimated the burden of OOP health payment on household living standards in rural Egypt using data from Household Income, Expenditure, and Consumption Survey in 2015. Rural areas exhibited a considerable incidence of catastrophic payments. Redefining subsistence spending better detected the incidence of catastrophic health expenditure among poor households. The distribution of CHE became highly regressive and demonstrated that catastrophic payments are more concentrated among poor households. Although poor households have incurred relatively small health payments compared to wealthy ones, this has threatened their standard of living. The highest incidence rates of CHE were also observed among uneducated, unemployed, female, elderly heads, among households with chronically ill members, and those who experienced outpatient services. The poor performance of the health insurance system in protecting vulnerable groups from catastrophic payments creates a critical need to redesign its policies and improve its service quality.

摘要

减少自费 (OOP) 医疗费用是保护家庭免受财务风险和消除极端贫困的重要因素。本文旨在通过重新定义生存支出以包含所有必需品的最低可接受水平，提供一种衡量灾难性医疗支出 (CHE) 的新方法。新方法将 OOP 卫生支出定义为灾难性支出，前提是它们破坏了家庭维持基本需求的能力，而这些基本需求不仅限于支付能力 (CTP) 方法所假设的食物需求。估计等效量表以反映主要消费模式，并采用基本需求成本法 (CBN) 来衡量生活开支。我们使用家庭收入的数据估计了埃及农村家庭生活水平的 OOP 医疗支付负担，2015 年支出和消费调查。农村地区出现了相当大的灾难性支付事件。重新定义生活支出可以更好地发现贫困家庭灾难性医疗支出的发生率。CHE 的分布变得高度回归并表明灾难性支付更集中在贫困家庭中。尽管与富裕家庭相比，贫困家庭支付的医疗费用相对较少，但这已威胁到他们的生活水平。在未受过教育、失业、女性、老年户主、有慢性病成员的家庭和经历过门诊服务的家庭中，也观察到 CHE 的发病率最高。