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首页> 外文期刊>International journal for equity in health >Constraints to universal coverage: inequities in health service use and expenditures for different health conditions and providers
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Constraints to universal coverage: inequities in health service use and expenditures for different health conditions and providers

机译：普遍覆盖的制约因素：针对不同健康状况和提供者的卫生服务使用和支出不平等

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Background There is need for new information about the socio-economic and geographic differences in health seeking and expenditures on many health conditions, so to help to design interventions that will reduce inequity in utilisation of healthcare services and ensure universal coverage. Objectives The paper contributes additional knowledge about health seeking and economic burden of different health conditions. It also shows the level of healthcare payments in public and private sector and their distribution across socioeconomic and geographic population groups. Methods A questionnaire was used to collect data from randomly selected householders from 4,873 households (2,483 urban and 2,390 rural) in southeast Nigeria. Data was collected on: health problems that people had and sought care for; type of care sought, outpatient department (OPD) visits and inpatient department (IPD) stays; providers visited; expenditures; and preferences for improving access to care. Data was disaggregated by socio-economic status (SES) and geographic location (urban versus rural) of the households. Results Malaria and hypertension were the major communicable and non-communicable diseases respectively that required OPD and IPD. Patent medicine dealers (PMDs) were the most commonly used providers (41.1%), followed by private hospitals (19.7%) and pharmacies (16.4%). The rural dwellers and poorer SES groups mostly used low-level and informal providers. The average monthly treatment expenditure in urban area was 2444 Naira (US$20.4) and 2267 Naira (US$18.9) in the rural area. Higher SES groups and urbanites incurred higher health expenditures. People that needed healthcare services did not seek care mostly because the health condition was not serious enough or they could not afford the cost of services. Conclusion There were inequities in use of the different providers, and also in expenditures on treatment. Reforms should aim to decrease barriers to access to public and formal health services and also identify constraints which impede the equitable distribution and access of public health services for the general population especially for poor people and rural dwellers.
机译：背景技术需要有关在寻求健康和许多健康状况上的支出方面的社会经济和地理差异的新信息，以便帮助设计干预措施，以减少医疗服务利用的不公平性并确保全民覆盖。目标本文提供了有关寻求健康和不同健康状况的经济负担的其他知识。它还显示了公共和私营部门的医疗保健支付水平及其在社会经济和地理人口群体中的分布。方法使用问卷调查从尼日利亚东南部的4873户（2483个城市和2390个农村）的家庭中随机抽取的数据。收集了有关以下方面的数据：人们曾经寻求并寻求护理的健康问题;寻求的护理类型，门诊（OPD）访问和住院（IPD）停留时间;提供者参观;支出;以及改善获得医疗服务的偏好。数据按家庭的社会经济地位（SES）和地理位置（城市还是农村）进行了分类。结果疟疾和高血压分别是需要OPD和IPD的主要传染病和非传染病。专利药经销商（PMD）是最常用的提供者（41.1％），其次是私家医院（19.7％）和药房（16.4％）。农村居民和较贫穷的SES群体大多使用低级和非正式的提供者。在城市地区，农村地区的平均月治疗支出为2444奈拉（20.4美元），在农村地区为2267奈拉（18.9美元）。较高的SES群体和城市居民产生了更高的卫生支出。需要医疗保健服务的人之所以没有寻求医疗服务，主要是因为健康状况不够严重或他们负担不起服务费用。结论不同提供者的使用存在不公平性，治疗费用也存在差异。改革应旨在减少获得公共和正规卫生服务的障碍，并查明阻碍普通大众，特别是穷人和农村居民公平分配和获得公共卫生服务的制约因素。

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