背景:在中低收入国家(LMICs),非传染性疾病(NCDs)呈上升趋势,已成为死亡的重要原因。不幸的是,对于无法自掏腰包承担费用的个人来说,获得负担得起的医疗服务可能是一项挑战。对于非传染性疾病,治疗费用已经很高了,并且被多重性进一步扩大了患者及其家人的经济负担。本研究旨在弥合有关NCD多发病率带来的财务风险的知识差距。它通过在TikurAnbesa专科医院检查灾难性的自付(OOP)支出水平以及导致其的因素来实现这一目标,亚的斯亚贝巴,埃塞俄比亚。
方法:于2020年5月18日至7月22日在TikurAnbesa专科医院进行了一项基于设施的横断面研究,392名多名患者参加了研究。使用系统随机抽样从医院的四个NCD诊所中选择研究参与者。记录患者的直接医疗和非医疗自付(OOP)支出,使用各种阈值作为截止点(5%,10%,15%,20%,25%,占家庭消费支出和非食品支出总额的40%)。将收集的数据输入到Epi数据版本3.1中,并使用STATAV14进行分析。描述性统计数据被用来展示研究结果,而逻辑回归用于检查变量之间的关联。
结果:对392名表现出一系列社会人口统计学和经济背景的患者进行了一项研究。非传染性疾病多重性疾病治疗的年度自付支出为每位患者499.7美元(95%CI:440.9美元,558.6美元)。这些费用中的大部分被分配给医疗费用,如药物治疗,诊断,和医院病床。结果发现,随着支出门槛从家庭消费总支出的5%增加到40%,面临灾难性卫生支出(CHE)的家庭百分比从77.55下降到10.46%。同样,CHE占非食品家庭支出的百分比从91.84下降到28.32%,门槛从5%增加到40%。该研究还显示,前往亚的斯亚贝巴寻求医疗保健服务的患者(AOR=7.45,95%CI:3.41-16.27),未参加保险计划的人(AOR=4.97,95%CI:2.37,10.4),非传染性疾病较多(AOR=2.05,95%CI:1.40,3.01),或门诊量较多(AOR=1.46,95CI:1.31,1.63)的患者在40%的阈值下发生灾难性自付医疗支出的可能性较高.
结论:这项研究表明,由于医疗和非医疗费用,患有多种非传染性疾病(NCD)的患者经常面临大量的自付医疗支出(CHE)。各种因素,包括没有参加保险计划,医疗后续行动需要前往亚的斯亚贝巴,多种非传染性疾病和门诊就诊,公共和私人设施的利用,增加发生CHE的可能性。为了减轻NCD多病患者CHE的发生率,综合非传染性疾病护理服务提供方法,在公共设施中获得负担得起的药物和诊断服务,扩大保险范围,应探索费用减免或服务豁免制度。
BACKGROUND: In low and middle-income countries (LMICs), non-communicable diseases (NCDs) are on the rise and have become a significant cause of mortality. Unfortunately, accessing affordable healthcare services can prove to be challenging for individuals who are unable to bear the expenses out of their pockets. For NCDs, the treatment costs are already high, and being multimorbid further amplifies the economic burden on patients and their families. The present study seeks to bridge the gap in knowledge regarding the financial risks that come with NCD multimorbidity. It accomplishes this by examining the catastrophic out-of-pocket (OOP) expenditure levels and the factors that contribute to it at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia.
METHODS: A facility-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospital between May 18 and July 22, 2020 and 392 multimorbid patients participated. The study participants were selected from the hospital\'s four NCD clinics using systematic random sampling. Patients\' direct medical and non-medical out-of-pocket (OOP) expenditures were recorded, and the catastrophic OOP health expenditure for NCD care was estimated using various thresholds as cutoff points (5%, 10%, 15%, 20%, 25%, and 40% of both total household consumption expenditure and non-food expenditure). The collected data was entered into Epi Data version 3.1 and analyzed using STATA V 14. Descriptive statistics were utilized to present the study\'s findings, while logistic regression was used to examine the associations between variables.
RESULTS: A study was conducted on a sample of 392 patients who exhibited a range of socio-demographic and economic backgrounds. The annual out-of-pocket spending for the treatment of non-communicable disease multimorbidity was found to be $499.7 (95% CI: $440.9, $558.6) per patient. The majority of these expenses were allocated towards medical costs such as medication, diagnosis, and hospital beds. It was found that as the threshold for spending increased from 5 to 40% of total household consumption expenditure, the percentage of households facing catastrophic health expenditures (CHE) decreased from 77.55 to 10.46%. Similarly, the proportion of CHE as a percentage of non-food household expenditure decreased from 91.84 to 28.32% as the threshold increased from 5 to 40%. The study also revealed that patients who traveled to Addis Ababa for healthcare services (AOR = 7.45, 95% CI: 3.41-16.27), who were not enrolled in an insurance scheme (AOR = 4.97, 95% CI: 2.37, 10.4), who had more non-communicable diseases (AOR = 2.05, 95% CI: 1.40, 3.01), or who had more outpatient visits (AOR = 1.46, 95%CI: 1.31, 1.63) had a higher likelihood of incurring catastrophic out-of-pocket health expenditures at the 40% threshold.
CONCLUSIONS: This study has revealed that patients with multiple non-communicable diseases (NCDs) frequently face substantial out-of-pocket health expenditures (CHE) due to both medical and non-medical costs. Various factors, including absence from an insurance scheme, medical follow-ups necessitating travel to Addis Ababa, multiple NCDs and outpatient visits, and utilization of both public and private facilities, increase the likelihood of incurring CHE. To mitigate the incidence of CHE for individuals with NCD multimorbidity, an integrated NCD care service delivery approach, access to affordable medications and diagnostic services in public facilities, expanded insurance coverage, and fee waiver or service exemption systems should be explored.