The socioeconomic and health system determinants of financial protection indicators: a global systematic review (2008–2023)

作者：Bingqing Guo, Xin Peng, Joshua Tran, Shaz Cheng, Karen A. Grépin · 发表于：BMJ Global Health · 年份：2025 · DOI：10.1136/bmjgh-2024-017859 · 被引用次数：5 · 研究领域：Healthcare Systems and Reforms、Healthcare Policy and Management、Food Security and Health in Diverse Populations

INTRODUCTION: To ensure financial protection (FP), a key component of achieving Universal Health Coverage, it is important to identify the most vulnerable populations to financial hardship; however, systematic evidence of the determinants of FP is lacking, especially regarding the ability of FP indicators to identify the most vulnerable populations. METHODS: We searched three English (Web of Science, Medline and Embase) and four Chinese (CNKI, Wanfang, VIP and SinoMed) language databases for articles published between 1 January 2008 and 13 September 13, 2023. Eligible studies reported associations between a socioeconomic and/or health system determinant and either catastrophic (CHE) or impoverishing health expenditures (IHE). Joanna-Briggs Institute Checklist for Analytical Cross-sectional Studies was used to assess study quality. Key patterns in the associations between determinants and FP outcomes were summarised descriptively (PROSPERO ID: 585024). RESULTS: We identified 52 842 potentially eligible studies, of which 85 studies, or 1 308 separate associations between a determinant and a FP outcome, were included in the review, covering all WHO regions. Some clear patterns were identified: households in rural areas, with older members, lacking private insurance, or with inpatient or outpatient care utilisation experienced a higher risk of CHE and IHE. Smaller households, or those lacking any form of health insurance, and lower income were also at higher risk, although the as...