臺灣經濟衰退下家庭收入與醫療財務災難之關係

Economic downturn and changing relation between household income and catastrophic health expenditure in Taiwan, 1998-2018

楊貽婷(Yi-Ting Yang)

指導教授 ： 江東亮

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2022年)

https://doi.org/10.6342/NTU202202216

摘要

背景及目的：臺灣家庭自費支出占國民醫療保健支出的比例越來越高，目前已超過35%；對所有家庭而言，都是一筆不小的負擔，尤其低收入家庭的財務狀況，當經濟不景氣來臨時，更可能因此陷入困境。本研究之目的是以醫療財務災難作為衡量家庭財務風險的指標，探討當景氣差時，高收入與低收入家庭之間，發生醫療財務災難之比例的差距是否擴大。
方法：本研究分析的資料，主要來自1998-2018年行政院主計總處之家庭收支調查。依變項是醫療財務災難，意指自付醫療保健支出占家庭支付能力（以總消費支出為計算基礎）之比例高於閾值的情況；本研究採用三種閾值：10%、25%、40%。自變項是家庭收入（即可支配所得），依五分位數劃分為：低、中低、中、中高及高收入組。另一個自變項是經濟景氣，資料主要來自國發會的景氣指標查詢系統。本研究以經濟景氣作為分層的變項，分析不同家庭收入的組別之間醫療財務災難率的差距；最後以羅吉斯迴歸分析家庭收入與經濟景氣之間是否存在交互作用。
結果：以閾值25%為例，平均醫療財務災難率由低至高收入組依序為：1.82%、1.48%、1.14%、1.11%、1.25%。與景氣好時相比，景氣差時，低收入組和高收入組的醫療財務災難率之差距由1.31倍擴大為1.44倍，顯見當景氣差時兩者的差距會擴大。在羅吉斯迴歸分析中，以高收入組和景氣好為參考組時，家庭收入與經濟景氣之交互作用的結果，在低收入組和中低收入組中皆呈現顯著（p<0.0001）。以閾值10%和40%進行計算時，呈現的結果和趨勢與上述皆相同。
結論：本研究發現，當景氣差時，高收入與低收入家庭發生醫療財務災難的比例差距會擴大，顯示低收入家庭受到更大的衝擊。因此，建議當總體經濟狀況較差時，政府可透過額外補助等方式，避免低收入家庭因健康問題而進一步陷入經濟困境。

關鍵字

家庭收入 ； 醫療財務災難 ； 醫療保健支出 ； 經濟衰退 ； 家庭收支調查

並列摘要

Objective: The percentage of out-of-pocket expenditure in national health expenditure for households in Taiwan has increased in recent years and has exceeded 35% at the time of writing. This expenditure poses a substantial burden on all affected families. During economic downturns, the financial situation for low-income households subjected to said burden may become particularly desperate. This study employs catastrophic health expenditure as an indicator for measuring household financial risks to determine whether the gap between high-income and low-income families in terms of experiencing catastrophic health expenditure expanded.
Methods: This study analyzed data from the Survey of Family Income and Expenditure from 1998–2018 collected by the Directorate-General of Budget, Accounting, and Statistics of the Executive Yuan, Taiwan. The dependent variable was set as catastrophic health expenditure, which referred to the situation in which health expenditure accounted for more than the threshold value of a household’s ability to pay (calculated based on the total consumption expenditure of a household). Three threshold values were employed in this study, namely 10%, 25%, and 40 %. This study employed household income and economic condition as independent variables. First, household income (i.e., disposable income) was used to divide samples into five groups using quintiles: low, medium-low, medium, medium-high, and high-income households. Next, economic conditions were used for stratification to analyze the differences of the catastrophic health expenditure rates among groups with different household incomes. This study obtained data on economic conditions from the Business Indicators Database of the National Development Council. Finally, logistic regression was employed to analyze whether interactions exist between household income and economic conditions.
Results: Take the threshold value of 25% as an example. The mean catastrophic health expenditure rate of the low, medium-low, medium, medium-high, and high-income households was 1.82%, 1.48%, 1.14%, 1.11%, and 1.25%. Compared to favorable economic conditions, when the economic conditions were unfavorable, the difference between the catastrophic health expenditure rate of the low-income group and high-income group increased from 1.31 times to 1.44 times. Evidently, when the economic conditions were unfavorable, the difference between the two expanded. Regarding the logistic regression analysis results, when the high-income group and favorable economic conditions were used as the reference group, the interactions between household income and economic conditions were significant in the low and medium-low income groups (p<0.0001). When the threshold value was 10% and 40%, the calculation results and trend were the same as above.
Conclusion: This study discovered that when economic conditions are unfavorable, the gap between high-income and low-income families in terms of experiencing catastrophic health expenditure expanded, thereby indicating that low-income households sustain a greater impact from economic downturns. Accordingly, this study suggests that when the overall economic situation is unfavorable, the government may provide additional subsidies to low-income households to alleviate their financial burdens caused by health problems.

並列關鍵字

household income ； catastrophic health expenditure ； health expenditure ； economic downturn ； The Survey of Family Income and Expenditure

參考文獻

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