도시가계 의료비 지출의 형평성

Abstract

This paper used two threshold approaches to measure the equity in urban households' out-of-pocket payments for health care from 1997 to 2002, which developed by Wagstaff and van Doorslaer. One approach used catastrophic health expenditure, which means that payments exceed a 'pre-specified proportion' of total consumption expenditures or ability to pay and the other used impoverishment that they did not drive households into poverty. Indicies for 'catastrophic expenditure' captured intensity as well as its incidence and also the degree of which catastrophic payments occur disproportionately among poor households. Measure of poverty impact also captured both intensity and incidence. The methods applied with data on out-of-pocket payments from the Urban Household Expenditure Survey Incidence and intensity of catastrophic payments - both in terms of total household consumption as well as ability to pay - increased between 1997 and 2002, and that both incidence and intensity of 'catastrophic expenditure' became less concentrated among the poor, but more concentrated in 2001 than in 1997. The incidence and intensity of the poverty impact of out-of-pocket payments increased between 1997 and 2002. Health security system may not have provided financial protection against catastrophic health expenditure to low-income households, because of high user fee policy not considering income level. The policies alleviating catastrophic health payments among the poor need to be more developed, and two threshold approaches further evaluated on our policy context.