Asociación entre gastos de bolsillo de salud y pobreza utilizando datos de la Encuesta Permanente de Hogares en Paraguay en el 2014

Abstract

La cobertura y acceso universal de salud requiere de protección financiera, lo que puede evaluarse a través del gasto de bolsillo ante una enfermedad. El objetivo del trabajo fue analizar la asociación entre el gasto de bolsillo de salud y la pobreza en Paraguay. Se utilizó la Encuesta Permanente de Hogares del 2014 para determinar la razón entre gasto de bolsillo ante una enfermedad con los ingresos del hogar, con las transferencias estatales para pobres, con la canasta básica de consumo y de alimentos. Fueron incluidos 5.165 hogares de los cuales 21,49% eran pobres. Hubo gasto de bolsillo en el 45,19% de los hogares asociándose significativamente con la pobreza (OR: 1,8; IC95%: 1,57 a 2,06). El 1,99% de los hogares tuvo gasto de bolsillo mayor a 25% de sus ingresos y el 5,98% mayor a 10% de sus ingresos, ambos indicadores se asociaron significativamente con la pobreza (OR: 3,70; IC95%: 2,50 a 5,50 y OR: 3,04; IC95%: 2,40 a 2,06, respectivamente). Hubo empobrecimiento en el 1,44% de los hogares, y la brecha de la pobreza pasó de 34,58% a 37,67%. Entre los hogares pobres el gasto de bolsillo fue equivalente a 4,9 días de consumo, a 11,5 días de alimentación y a 42% del valor de transferencias estatales. Estos hallazgos reflejan una insuficiente protección financiera del sistema de salud en Paraguay.

Determinants of Out-of-Pocket Health Spending in Households in Peru in the Times of the Pandemic (COVID-19)

“…Peru has achieved economic expansion in recent years, allowing it to have suitable resources to be able to promote various reforms towards the social sectors, but it is also one of the countries with the lowest health spending in Latin America; therefore, health services for people are carried out through the Comprehensive Health System (SIS) and Social Health Security (ESSALUD), where by 2021, according to data from the National Institute of Statistics and Informatics (INEI), the largest number of people were insured through SIS, representing more than 60%, while an average of 37% were insured through ESSALUD, whose purpose is to guarantee and ensure protection and the right to health services to all residents of the country [ 33 , 34 , 35 , 36 ].…”

“…According to the indicators of the services provided by SIS and ESSALUD, they manage to provide effective financial and benefit coverage, since, in 2021, the Ministry of Health of Peru reported that the out-of-pocket spending of people who are affiliated with SIS increased from 18% in 2012 to 26% in 2019; in addition, the allocation of out-of-pocket spending oriented towards the acquisition of medicines increased to 35% in 2019, which demonstrates the existence of a gap in access to health services, which is conditioned by the payment capacity of clients or users, generating financial problems in households [ 33 , 34 , 35 , 36 ].…”

“…The WHO indicates that out-of-pocket spending should not exceed between 30% and 40% of total health spending. When a country is based more on direct payments, it will be more difficult to achieve universal access to quality health services [ 33 , 34 , 35 , 36 ].…”