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Abstract：
Multipurpose cash transfers (MPCs) are used on a widespread basis in the Syrian refugee response; however, there is little to no evidence as to how they affect health in humanitarian crises.
A prospective cohort study was conducted from May 2018 through July 2019 to evaluate the impact of MPCs on health care-seeking and expenditures for child, adult acute, and adult chronic illness by Syrian refugees in Lebanon. Households receiving MPCs from UNHCR were compared to control households not receiving UNHCR MPCs.
Care-seeking for childhood illness was consistently high in both MPC and non-MPC households. An increased proportion of households did not receive all recommended care due to cost; this increase was 19.3% greater among MPC recipients than controls (P = 0.002). Increases in child hospitalizations were significantly smaller among MPC recipients than controls (DiD -6.1%; P = 0.037). For adult acute illnesses, care-seeking increased among MPC recipients but decreased in controls (adjusted DiD 11.3%; P = 0.057); differences in change for other utilization outcomes were not significant. The adjusted difference in change in the proportion of MPC households not receiving recommended chronic illness care due to cost compared to controls was - 28.2% (P = 0.073). Access to medication for adult chronic illness also marginally significantly improved for MPC households relative to controls. The proportion of MPC recipients reporting expenses for the most recent child and adult acute illness increased significantly, as did the [log] total visit cost. Both MPC and control households reported significant increases in borrowing to pay for health expenses over the year study period, but differences in change in borrowing or asset sales were not significant, indicating that MPC was not protective against for household financial risks associated with health.
While MPC may have shown some positive effects, findings were mixed and MPC appears insufficient on its own to address health utilization and expenditures. A broader strategy addressing Syrian refugee health in Lebanon is needed of which MPC should be incorporated, with additional support such as additional conditional cash transfers for health.
A prospective cohort study was conducted from May 2018 through July 2019 to evaluate the impact of MPCs on health care-seeking and expenditures for child, adult acute, and adult chronic illness by Syrian refugees in Lebanon. Households receiving MPCs from UNHCR were compared to control households not receiving UNHCR MPCs.
Care-seeking for childhood illness was consistently high in both MPC and non-MPC households. An increased proportion of households did not receive all recommended care due to cost; this increase was 19.3% greater among MPC recipients than controls (P = 0.002). Increases in child hospitalizations were significantly smaller among MPC recipients than controls (DiD -6.1%; P = 0.037). For adult acute illnesses, care-seeking increased among MPC recipients but decreased in controls (adjusted DiD 11.3%; P = 0.057); differences in change for other utilization outcomes were not significant. The adjusted difference in change in the proportion of MPC households not receiving recommended chronic illness care due to cost compared to controls was - 28.2% (P = 0.073). Access to medication for adult chronic illness also marginally significantly improved for MPC households relative to controls. The proportion of MPC recipients reporting expenses for the most recent child and adult acute illness increased significantly, as did the [log] total visit cost. Both MPC and control households reported significant increases in borrowing to pay for health expenses over the year study period, but differences in change in borrowing or asset sales were not significant, indicating that MPC was not protective against for household financial risks associated with health.
While MPC may have shown some positive effects, findings were mixed and MPC appears insufficient on its own to address health utilization and expenditures. A broader strategy addressing Syrian refugee health in Lebanon is needed of which MPC should be incorporated, with additional support such as additional conditional cash transfers for health.
摘要：
多用途现金转移(MPC)在叙利亚难民应对中被广泛使用；然而，几乎没有证据表明它们在人道主义危机中如何影响健康。
从2018年5月至2019年7月进行了一项前瞻性队列研究，以评估MPC对儿童寻求医疗保健和支出的影响。成人急性，和在黎巴嫩的叙利亚难民的成人慢性疾病。从难民署接受MPC的家庭与未接受难民署MPC的控制家庭进行了比较。
在MPC和非MPC家庭中，寻求儿童疾病的护理一直很高。由于成本原因，未接受所有推荐护理的家庭比例增加；MPC接受者的这一增长比对照组高19.3％（P=0.002）。MPC接受者中儿童住院率的增加明显小于对照组（DiD-6.1％；P=0.037）。对于成人急性疾病，MPC受者寻求护理的比例增加,但对照组减少(调整后的DiD11.3%;P=0.057);其他利用结局的变化差异不显著.与对照组相比，由于费用而未接受推荐的慢性病护理的MPC家庭比例的调整后差异为-28.2％（P=0.073）。与对照组相比，MPC家庭获得成人慢性病的药物治疗也略有改善。报告最近儿童和成人急性疾病费用的MPC接受者比例显着增加，[日志]总访问费用也是如此。MPC和对照家庭都报告了在年度研究期间用于支付医疗费用的借款显着增加，但借款或资产出售的变化差异不大，这表明MPC不能预防与健康相关的家庭财务风险。
虽然MPC可能显示出一些积极的影响，调查结果好坏参半，MPC本身似乎不足以解决健康利用和支出问题。需要一项解决黎巴嫩境内叙利亚难民健康问题的更广泛战略，应将MPC纳入其中，有额外的支持，如额外的有条件现金转移用于健康。
从2018年5月至2019年7月进行了一项前瞻性队列研究，以评估MPC对儿童寻求医疗保健和支出的影响。成人急性，和在黎巴嫩的叙利亚难民的成人慢性疾病。从难民署接受MPC的家庭与未接受难民署MPC的控制家庭进行了比较。
在MPC和非MPC家庭中，寻求儿童疾病的护理一直很高。由于成本原因，未接受所有推荐护理的家庭比例增加；MPC接受者的这一增长比对照组高19.3％（P=0.002）。MPC接受者中儿童住院率的增加明显小于对照组（DiD-6.1％；P=0.037）。对于成人急性疾病，MPC受者寻求护理的比例增加,但对照组减少(调整后的DiD11.3%;P=0.057);其他利用结局的变化差异不显著.与对照组相比，由于费用而未接受推荐的慢性病护理的MPC家庭比例的调整后差异为-28.2％（P=0.073）。与对照组相比，MPC家庭获得成人慢性病的药物治疗也略有改善。报告最近儿童和成人急性疾病费用的MPC接受者比例显着增加，[日志]总访问费用也是如此。MPC和对照家庭都报告了在年度研究期间用于支付医疗费用的借款显着增加，但借款或资产出售的变化差异不大，这表明MPC不能预防与健康相关的家庭财务风险。
虽然MPC可能显示出一些积极的影响，调查结果好坏参半，MPC本身似乎不足以解决健康利用和支出问题。需要一项解决黎巴嫩境内叙利亚难民健康问题的更广泛战略，应将MPC纳入其中，有额外的支持，如额外的有条件现金转移用于健康。
