Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2014 Jul;17(7):507-13.
Hospitalized patients constitute the main fraction of users in any health system. Financial burden of reimbursement for received services and cares by these users is sometimes unbearable and may lead to catastrophic medical payments. So, designing and implementing effective health prepayments schemes appear to be an effective governmental intervention to reduce catastrophic medical payments and protect households against it. We aimed to calculate the proportion of hospitalized patients exposed to catastrophic medical payments, its determinant factors and its distribution.
We conducted a cross sectional study with 400 samples in five hospitals affiliated with Tehran University of Medical Sciences (TUMS). A self-administered questionnaire was distributed among respondents. Data were analyzed by logistic regression and χ(2) statistics. Also, we drew the Lorenz curve and calculated the Gini coefficient in order to present the distribution of catastrophic medical payments burden on different income levels.
About 15.05% of patients were exposed to catastrophic medical payments. Also, we found that the educational level of the patient's family head, the sex of the patient's family head, hospitalization day numbers, having made any out of hospital payments linked with the same admission and households annual income levels; were linked with a higher likelihood of exposure to catastrophic medical payments. Also, the Gini coefficient is about 0.8 for catastrophic medical payments distribution.
There is a high level of catastrophic medical payments in hospitalized patients. The weakness of economic status of households and the not well designed prepayments schemes on the other hand may lead to this. This paper illustrated a clear picture for catastrophic medical payments at hospital level and suggests applicable notes to Iranian health policymakers and planners.
住院患者构成任何医疗体系中主要的用户群体。这些用户在偿还所接受的服务和护理费用方面的经济负担有时是难以承受的，可能导致灾难性的医疗支出。因此，设计和实施有效的健康预付款计划被认为是政府减少灾难性医疗支出、保护家庭免受其影响的有效干预措施。我们旨在计算面临灾难性医疗支出的住院患者比例、其决定因素及其分布情况。
我们在德黑兰医科大学（TUMS）的五家附属医院进行了一项横断面研究，共纳入 400 名样本。我们向受访者发放了一份自我管理的问卷。采用逻辑回归和卡方检验对数据进行分析。此外，我们绘制了洛伦兹曲线并计算了基尼系数，以展示不同收入水平下灾难性医疗支出负担的分布情况。
约有 15.05%的患者面临灾难性医疗支出。此外，我们发现患者家庭主要经济来源的教育水平、患者家庭主要经济来源的性别、住院天数、是否有与同一入院相关的院外支付以及家庭年收入水平与更高的可能性面临灾难性医疗支出有关。此外，灾难性医疗支出的基尼系数约为 0.8。
住院患者中存在较高水平的灾难性医疗支出。这可能是由于家庭经济状况较弱和预付款计划设计不当所致。本文清晰地描绘了医院层面灾难性医疗支出的情况，并为伊朗卫生政策制定者和规划者提供了可行的建议。
