陕西省糖尿病患者灾难性卫生支出及其不平等性分解

Diabetes-related household catastrophic healthcare expenditure and its income-related inequality in Shaanxi province: a decomposition analysis

目的分析糖尿病患者的灾难性卫生支出及其与收入相关的不平等性。方法利用陕西省国家卫生调查2013年数据,以糖尿病患者家庭为研究对象,利用WHO的方法界定的灾难性卫生支出,并进一步采用Probit模型、集中指数和集中指数分解法对研究结果进行分析。结果农村和城市糖尿病家庭灾难性卫生支出发生率分别为16.10%和21.98%,无慢性病家庭的9.73%和12.47%,同时相对差距与绝对差距也均高于无慢性病家庭;城市和农村糖尿病家庭灾难性卫生支出的集中指数分别为–0.287和–0.381,而无慢性病家庭灾难性卫生支出的集中指数为–0.535和–0.482,显示出强烈的倾向于低收入家庭的不平等;经济水平,是否有老人和卫生服务可及性解释了大部分的不平等。结论陕西省糖尿病患者面临较高的灾难性卫生支出发生率和倾向于低收入家庭的不平等。

Objective To examine diabetes-related household catastrophic healthcare expenditure（CHE） and its incomerelated inequality in Shaanxi province. Methods The data of the study was extracted from the Fifth National Health Service Survey conducted in 2013, which collected relevant information of 20 700 households in urban and rural Shaanxi province.The CHE was measured with the method defined by World Health Organization（WHO）. Probit model, concentration index（CI）, and decomposition of concentration index were adopted to analyze the inequality in CHE among the households surveyed. Results During 2013, the occurrence rate of CHE was 16.10% and 21.98% among the urban and rural households with one or more family members suffering from diabetes; while, the occurrence rate was 9.73% and 12.47% among the urban and rural households with no family member suffering from non-communicable disease. Both the relative and absolute gap between the capability to pay healthcare expenditure and the CHE were higher among the households with one or more diabetes sufferers than the households with no non-communicable disease sufferers. The CI of CHE was – 0.287 and– 0.381 for the urban and rural households with one or more diabetes sufferers; whereas the CI of CHE was – 0.535 and– 0.482 for the urban and rural households with no non-communicable disease sufferers, indicating a pro-poor inequality in CHE. The majority of the inequality in CHE could be explained by economic status, whether having an elderly member in a family, and the accessibility of healthcare service. Conclusion The diabetes sufferers in Shaanxi province are at a high risk of household catastrophic healthcare expenditure and have a pro-poor inequality in CHE.