Troškovi korištenja zdravstvenih usluga majki u zemljama niskog i srednjeg dohotka: sistematski pregled.
International journal of health policy and management
Sažetak istraživanja
Pozadina Troškovi su glavna prepreka korištenju zdravstvenih usluga za majke za mnoge žene u zemljama sa niskim i srednjim prihodima (LMIC). Međutim, uporedivi dokazi o dostupnim podacima o troškovima u ovim zemljama su ograničeni. We conducted a systematic review and comparative analysis of costs of utilising maternal health services in these settings.
Metode Pretražili smo recenzirane i sivu literaturu u bazama podataka za članke koji izvještavaju o troškovima korištenja zdravstvenih usluga majki u LMIC-ima objavljenim nakon 2000. godine. Svi preuzeti zapisi su pregledani i odabrani su članci koji ispunjavaju kriterijume za uključivanje. Procjena kvaliteta je izvršena korištenjem relevantnih kriterija specifičnih za troškove kontrolne liste Konsolidovanih standarda za izvještavanje o ekonomskoj evaluaciji zdravlja (CHEERS). Kako bi se zajamčila uporedivost, raščlanjeni podaci o troškovima naduvani su na ekvivalente u američkim dolarima iz 2019. godine. Total adjusted costs and cost drivers associated with utilising each service were systematically compared. Tamo gdje je uočena heterogenost u metodama ili nedezagregirani troškovi, korišćena je narativna sinteza za sumiranje nalaza.
Rezultati Trideset i šest studija je ispunilo naše kriterijume za uključivanje. Mnoge studije su koštale više usluga. Međutim, usluge koje se najčešće plaćaju bile su korištenje normalnog vaginalnog porođaja (22 studije), carski rez (13) i prenatalna njega (ANC) (10). Najjeftinije usluge bile su postnatalna nega (PNC) i nega nakon pobačaja (PAC) (po 5). Studije su koristile različite metode za prikupljanje i analizu podataka, a njihov kvalitet se kretao od niskog do visokog, a većina je ocijenjena kao prosječna ili visoka. Generalno, u svim uključenim studijama, troškovi korišćenja su se progresivno povećavali sa ANC i PNC na isporuku i PAC, i sa javnih na privatne pružaoce usluga. Medicines and diagnostics were main cost drivers for ANC and PNC while cost drivers were variable for delivery. Žene su iskusile finansijski teret korišćenja usluga materinskog zdravlja, a takođe su morale da plate neke nezvanične troškove za pristup nezi, čak i tamo gde su postojala formalna izuzeća.
Zaključak Konsenzus u vezi sa pristupom utvrđivanju troškova zdravstvenih usluga majki pomoći će da se poboljša njihova relevantnost za podršku kreiranju politike u pravcu postizanja univerzalne zdravstvene pokrivenosti. Ako je zaista misija globalne zajednice nakon 2015. da „nikog ne ostavi iza sebe“, onda moramo osigurati da se žene i njihove porodice ne suočavaju s nepotrebnim i nedopustivim troškovima koji bi ih potencijalno mogli dovesti u siromaštvo.
Prikaži originalni naslov i sažetak na engleskom
Cost of Utilising Maternal Health Services in Low- and Middle-Income Countries: A Systematic Review.
Background Cost is a major barrier to maternal health service utilisation for many women in low- and middle-income countries (LMICs). However, comparable evidence of the available cost data in these countries is limited. We conducted a systematic review and comparative analysis of costs of utilising maternal health services in these settings.
Methods We searched peer-reviewed and grey literature databases for articles reporting cost of utilising maternal health services in LMICs published post-2000. All retrieved records were screened and articles meeting the inclusion criteria selected. Quality assessment was performed using the relevant cost-specific criteria of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. To guarantee comparability, disaggregated costs data were inflated to 2019 US dollar equivalents. Total adjusted costs and cost drivers associated with utilising each service were systematically compared. Where heterogeneity in methods or non-disaggregated costs was observed, narrative synthesis was used to summarise findings.
Results Thirty-six studies met our inclusion criteria. Many of the studies costed multiple services. However, the most frequently costed services were utilisation of normal vaginal delivery (22 studies), caesarean delivery (13), and antenatal care (ANC) (10). The least costed services were post-natal care (PNC) and post-abortion care (PAC) (5 each). Studies used varied methods for data collection and analysis and their quality ranged from low to high with most assessed as average or high. Generally, across all included studies, cost of utilisation progressively increased from ANC and PNC to delivery and PAC, and from public to private providers. Medicines and diagnostics were main cost drivers for ANC and PNC while cost drivers were variable for delivery. Women experienced financial burden of utilising maternal health services and also had to pay some unofficial costs to access care, even where formal exemptions existed.
Conclusion Consensus regarding approach for costing maternal health services will help to improve their relevance for supporting policy-making towards achieving universal health coverage. If indeed the post-2015 mission of the global community is to "leave no one behind," then we need to ensure that women and their families are not facing unnecessary and unaffordable costs that could potentially tip them into poverty.
Izvorni podaci
- DOI
- 10.34172/ijhpm.2020.104
- PMID
- 32610819
- PMCID
- PMC9278371
- Provjereno
- 2026-07-26
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