2016年-世界发展银行全球_Health_Equity_and_Financial_Protection_in_Timor-Leste_32页_2mb

报告摘要

Summary of Health Equity and Financial Protection Report - Timor-Leste

Core Content

This report provides an in-depth analysis of health equity and financial protection in Timor-Leste, focusing on disparities in health outcomes, health care utilization, government spending, and health financing systems. It draws on data from household surveys such as the Demographic and Health Survey (DHS), Living Standards and Measurement Survey (TLSLS), and Household Income and Expenditure Survey (HIES), and uses the ADePT software for analysis. The report also compares Timor-Leste with other countries in the East Asia and Pacific (EAP) region.

Main Findings

1. Health Inequalities

Ill health is more concentrated among the poor in Timor-Leste. Key indicators such as infant mortality, under-five mortality, stunting, and underweight are higher among the poorest quintiles.
Wealthier households are more likely to report diarrhea, acute respiratory infection (ARI), and fever. This may be due to their ability to better recognize symptoms.
Smoking is more prevalent among the poor, both for men and women.
Obesity is more common among non-pregnant women in wealthier households.
Sexually transmitted diseases (STDs) are more prevalent among men in wealthier households.

2. Health Care Utilization Inequalities

Health care utilization is concentrated among the better-off.
Immunizations, treatment of ARI, and use of bed nets are higher among children from wealthier households.
Skilled antenatal care, skilled birth attendance, and contraceptive prevalence are also higher among women from wealthier households.
The utilization of secondary care, which is largely publicly-subsidized, is pro-rich, suggesting limited access for poorer populations.

3. Government Spending on Health

Government spending on health is pro-rich, particularly in hospital care.
For lower-level services (e.g., community health centers, health posts, and mobile clinics), government spending is pro-poor under two of three methodological assumptions.
Total subsidies for health are found to be pro-rich, indicating that the better-off benefit more from public health financing.
Public health expenditure as a share of total government expenditure is low, at 2.9% in 2011, compared to other EAP countries like Thailand (14.5%).
Health spending as a share of GDP is 5.1%, which is relatively low compared to other countries in the region.

4. Financial Protection in Health

Out-of-pocket (OOP) spending as a share of total health expenditure is 4.0%, which is lower than many EAP countries.
Only 0.9% of households spend 10% or more of their income on OOP health payments.
9.6% of households spend 10% or more of their non-food consumption on OOP health payments.
Health spending has a minor impact on increasing the poverty rate, with less than 1% of households falling under the $1.25/day poverty line due to health costs.
The distribution of health financing is progressive, with the wealthiest 20% covering 74% of total health care payments, compared to 39% of consumption.

5. Policy Implications

Improve frontline health services: The poor rely more on community health centers (CHCs) and mobile clinics, while the wealthy prefer hospitals. Strengthening the availability and quality of these services is essential to ensure equitable access.
Enhance access to secondary care: The utilization of secondary care is pro-rich, so mechanisms such as travel vouchers or partial reimbursement should be explored to improve access for the poor.
Monitor fiscal impacts on public health spending: As fiscal space tightens, the poor are likely to be more affected. The government should closely monitor the impact of budget cuts on service utilization, especially for poor households, and ensure that catastrophic OOP expenditures are minimized.

Key Information

Health expenditure per capita in 2011 was US$33.1 (current) and US$58.1 (PPP).
Government expenditure on health as a share of total health expenditure (THE) was 71.5%.
Out-of-pocket spending on health was 4.0% of THE, much lower than other EAP countries.
Public health expenditure as a share of government expenditure was 2.9%, which is lower than in 2005 (12%).
Government health spending is highly centralized, with a large portion coming from the Petroleum Fund.
Timor-Leste is on track to meet the WHO recommended health worker density of 2.35 per 1,000 population by the end of 2013, due to the influx of Cuban-trained doctors.

Conclusion

The report highlights significant health inequalities between the poor and the rich, with ill health more concentrated among the poor. While government spending is pro-rich, OOP spending is relatively low and has a minor impact on financial well-being. The progressivity of health financing is noted, but the distribution of services and fiscal allocation remain challenges for equity and access. Policy recommendations focus on strengthening frontline services, improving access to secondary care, and monitoring the impact of budget constraints on health outcomes.