Economic impacts of chronic conditions in a country with high levels of population health coverage: lessons from Mongolia.

Autor: Dugee O; National Center for Public Health, Ministry of Health, Ulaanbaatar, Mongolia.; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Sugar B; Department of Population and Social Statistics, National Statistical Office, Ulaanbaatar, Mongolia., Dorjsuren B; Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland., Mahal A; Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2019 Jun; Vol. 24 (6), pp. 715-726. Date of Electronic Publication: 2019 Apr 01.
DOI: 10.1111/tmi.13231
Abstrakt: Objective: To analyse the impact of non-communicable diseases (NCDs) on household out-of-pocket (OOP) expenses, catastrophic health payments and medical impoverishment in Mongolia, a middle-income country with a high population health insurance coverage rate.
Methods: Secondary data analysis of the Mongolian Household Socioeconomic Survey with 12 840 households, including information on standard of living, OOP spending, and health conditions of household members. Measures of catastrophic spending and medical impoverishment were constructed for Mongolia. The association of medical impoverishment and catastrophic spending with a range of socioeconomic and demographic covariates and health conditions was assessed using multiple regression models.
Results: OOP health spending contributed to an 8% increase in the incidence of poverty in Mongolia. The impoverishment associated with medical expenses is concentrated in the poorer quintiles, indicating some deepening of poverty among the already poor. Households with a member affected by NCDs and with multiple morbidities were more likely to experience catastrophic spending and medical impoverishment than those with infectious diseases. The main drivers of the financial distress were expenditures incurred for outpatient services, including for diagnostics and drugs.
Conclusion: Despite high rates of population health insurance coverage, health expenditures have substantial impoverishing effects in Mongolia, with the impacts being greater among households containing individuals with chronic conditions. Addressing the goal of universal health coverage (UHC) in Mongolia needs attention to the depth of coverage, especially for expenditures on outpatient care and medicines, and targeting the poor effectively.
(© 2019 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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