2018年-世界发展银行全球_Progress_on_Catastrophic_Health_Spending_in_133_Countries___A_Retrospective_Observational_Study_11页_845kb

Summary of "Progress on catastrophic health spending in 133 countries: a retrospective observational study"

Core Content

This study provides a comprehensive analysis of catastrophic health spending across 133 countries between 1984 and 2015. It focuses on the financial burden of health expenditures on households and evaluates how this burden has changed over time, as well as its relationship with macroeconomic and health system variables.

Main Findings

• Catastrophic Health Spending Definition: The study defines catastrophic health spending as exceeding 10% or 25% of household consumption. It also compares this with an alternative definition using non-food consumption, where the threshold is 40%.

• Global Trends:

  • In 2000, the global incidence of catastrophic spending at the 10% threshold was 9.7%.
  • By 2005, it rose to 11.4%.
  • In 2010, it reached 11.7%, with 808.4 million people affected globally.
  • At the 25% threshold, the global incidence was 2.6% in 2010, affecting 179.3 million people.
  • Using the 40% non-food consumption threshold, the global incidence was 3.0%, affecting 208.2 million people.

• Regional Variations:

  • Latin America and the Caribbean had the highest incidence at the 10% threshold in 2010 (14.8%).
  • Oceania had the lowest incidence (3.9%).
  • Africa and Asia had high levels of catastrophic spending, particularly at the 10% threshold.

• Trends Over Time:

  • For 94 countries with two or more survey datapoints, the population-weighted median annual rate of change of catastrophic payment incidence was positive for all measures.
  • The incidence of catastrophic spending is positively correlated with GDP per person and the share of GDP spent on health.
  • It is negatively correlated with the share of health spending channelled through social security funds and other government agencies.

• Coverage and Financial Protection:

  • The proportion of the population covered by health insurance or national/subnational health services is a poor indicator of financial protection.
  • Prepaid health spending—especially through taxes and mandatory contributions—is more strongly associated with reducing catastrophic spending than simply increasing health spending as a share of GDP.

Key Information

• Data Sources:

  • The study uses household survey data from 553 datasets across 133 countries.
  • These surveys are nationally representative and cover the period from 1984 to 2015.
  • Out-of-pocket spending is defined as payments made directly by households for health services, including cost-sharing and informal payments, but excluding third-party payments.

• Methodology:

  • The study uses multiple regression analysis to explore the relationship between catastrophic spending and macroeconomic and health system indicators.
  • It aggregates data from household surveys to estimate national and global incidence.
  • For countries without direct survey data, interpolation, model-based estimates, and regional median values are used.

• Limitations and Considerations:

  • The study acknowledges that income-based measures are less reliable in low-income and middle-income countries due to difficulties in accurately measuring income.
  • It uses consumption as the proxy for ability to pay, which can lead to greater inequality in catastrophic spending compared to income-based measures.
  • The study also notes that survey comprehensiveness varies, and it is challenging to ensure equal coverage across all countries.

Implications

• Policy Insight:

  • Simply increasing health spending as a share of GDP is not sufficient to ensure financial protection.
  • The prepayment mechanism—especially through public funding—is crucial in reducing the incidence of catastrophic spending.

• Future Research:

  • The study highlights the need for more detailed data on prepayment arrangements and health service coverage.
  • It emphasizes the importance of examining both service coverage and financial protection together to fully understand UHC progress.

• Additional Context:

  • A companion paper presents results for medical impoverishment, an alternative indicator of financial protection.
  • The study is part of a broader effort to monitor UHC through the Sustainable Development Goals (SDGs).

Conclusion

The study reveals that while the global incidence of catastrophic health spending has remained relatively stable over the past decade, it varies significantly across regions and countries. It underscores the importance of prepayment mechanisms in reducing financial hardship and highlights the limitations of using coverage rates alone to assess financial protection.