Abstract：
BACKGROUND: There is an important gap in the literature concerning the level, inequality, and evolution of financial protection for indigenous (IH) and non-indigenous (NIH) households in low- and middle-income countries. This paper offers an assessment of the level, socioeconomic inequality and middle-term trends of catastrophic (CHE), impoverishing (IHE), and excessive (EHE) health expenditures in Mexican IHs and NIHs during the period 2008-2020.
METHODS: We conducted a pooled cross-sectional analysis using the last seven waves of the National Household Income and Expenditure Survey (n = 315,829 households). We assessed socioeconomic inequality in CHE, IHE, and EHE by estimating their Wagstaff concentration indices according to indigenous status. We adjusted the CHE, IHE, and EHE by estimating a maximum-likelihood two-stage probit model with robust standard errors.
RESULTS: We observed that, during the period analyzed, CHE, IHE, and EHE were concentrated in the poorest IHs. CHE decreased from 5.4% vs. 4.7% in 2008 to 3.4% vs. 2.9% in 2014 in IHs and NIHs, respectively, and converged at 2008 levels towards 2020. IHE remained unchanged from 2008 to 2014 (1.6% for IHs vs. 1.0% for NIHs) and increased by 40% in IHs and NIHs during 2016-2020. EHE plunged in 2014 (4.6% in IHs vs. 3.8% in NIHs), then rose, and remained unchanged during 2016-2020 (6.7% in IHs and 5.6% in NIHs).
CONCLUSIONS: In pursuit of universal health coverage, health authorities should formulate and implement effective financial protection mechanisms to address structural inequalities, especially forms of discrimination including racialization, that vulnerable social groups such as indigenous peoples have systematically faced. Doing so would contribute to closing the persistent ethnic gaps in health.
METHODS: We conducted a pooled cross-sectional analysis using the last seven waves of the National Household Income and Expenditure Survey (n = 315,829 households). We assessed socioeconomic inequality in CHE, IHE, and EHE by estimating their Wagstaff concentration indices according to indigenous status. We adjusted the CHE, IHE, and EHE by estimating a maximum-likelihood two-stage probit model with robust standard errors.
RESULTS: We observed that, during the period analyzed, CHE, IHE, and EHE were concentrated in the poorest IHs. CHE decreased from 5.4% vs. 4.7% in 2008 to 3.4% vs. 2.9% in 2014 in IHs and NIHs, respectively, and converged at 2008 levels towards 2020. IHE remained unchanged from 2008 to 2014 (1.6% for IHs vs. 1.0% for NIHs) and increased by 40% in IHs and NIHs during 2016-2020. EHE plunged in 2014 (4.6% in IHs vs. 3.8% in NIHs), then rose, and remained unchanged during 2016-2020 (6.7% in IHs and 5.6% in NIHs).
CONCLUSIONS: In pursuit of universal health coverage, health authorities should formulate and implement effective financial protection mechanisms to address structural inequalities, especially forms of discrimination including racialization, that vulnerable social groups such as indigenous peoples have systematically faced. Doing so would contribute to closing the persistent ethnic gaps in health.
摘要：
背景：在有关该级别的文献中存在重要差距，不平等,以及低收入和中等收入国家对土著（IH）和非土著（NIH）家庭的金融保护的演变。本文提供了一个评估的水平，社会经济不平等和灾难性中期趋势(CHE)，贫困（IHE），以及2008-2020年期间墨西哥IH和NIH的过度(EHE)卫生支出。
方法：我们使用全国家庭收入和支出调查的最后七波（n=315,829户）进行了汇总横截面分析。我们评估了CHE的社会经济不平等，IHE,和EHE通过根据土著身份估计他们的Wagstaff浓度指数。我们调整了CHE，IHE,和EHE，通过估计具有鲁棒标准误差的最大似然两阶段概率模型。
结果：我们观察到，在分析期间，CHE,IHE,EHE集中在最贫穷的IH中。CHE从5.4%下降到2008年为4.7%，为3.4%，而不是2014年IHs和NIHs的2.9%，分别,并在2020年之前达到2008年的水平。IHE从2008年到2014年保持不变（IHs为1.6%，而NIHs为1.0%)，2016-2020年IHs和NIHs增长40%。EHE在2014年暴跌（IHs为4.6%，而3.8%的NIHs），然后Rose,在2016-2020年期间保持不变（IHs为6.7%，NIHs为5.6%）。
结论：为了实现全民健康覆盖，卫生当局应制定和实施有效的财政保护机制，以解决结构性不平等问题，特别是包括种族化在内的歧视形式，土著人民等弱势社会群体有系统地面临的问题。这样做将有助于缩小健康方面持续存在的种族差距。
方法：我们使用全国家庭收入和支出调查的最后七波（n=315,829户）进行了汇总横截面分析。我们评估了CHE的社会经济不平等，IHE,和EHE通过根据土著身份估计他们的Wagstaff浓度指数。我们调整了CHE，IHE,和EHE，通过估计具有鲁棒标准误差的最大似然两阶段概率模型。
结果：我们观察到，在分析期间，CHE,IHE,EHE集中在最贫穷的IH中。CHE从5.4%下降到2008年为4.7%，为3.4%，而不是2014年IHs和NIHs的2.9%，分别,并在2020年之前达到2008年的水平。IHE从2008年到2014年保持不变（IHs为1.6%，而NIHs为1.0%)，2016-2020年IHs和NIHs增长40%。EHE在2014年暴跌（IHs为4.6%，而3.8%的NIHs），然后Rose,在2016-2020年期间保持不变（IHs为6.7%，NIHs为5.6%）。
结论：为了实现全民健康覆盖，卫生当局应制定和实施有效的财政保护机制，以解决结构性不平等问题，特别是包括种族化在内的歧视形式，土著人民等弱势社会群体有系统地面临的问题。这样做将有助于缩小健康方面持续存在的种族差距。
