Anbari Zohreh, Mohammadbeigi Abolfazl, Mohammadsalehi Narges, Ebrazeh Ali
Department of Education Development Center, Arak University of Medical Sciences, Arak, Iran.
Department of Epidemiology and Biostatistics, School of Health, Qom University of Medical Sciences, Qom, Iran ; Health Policy and Promotion Research Center, Qom, Iran.
Int J Prev Med. 2014 Aug;5(8):1023-8.
Protecting households from risk of impoverishment due to out-of-pocket costs in health care is a major challenge for health systems. Therefore, this study aimed at evaluating some health expenditure of inpatient and outpatient care as well as assessing the predictors of catastrophic costs for inpatient care in one of central provinces of Iran.
In this cross-sectional study, 760 household were selected by multistage sampling method in Markazi province of Iran and interviewed in order to complete a standard questionnaire. Catastrophic costs were evaluated in a scale that varied from 0 (no money for care) to 100 (spending all income and wealth). Patients who were paid over 20% of household financial sources or 40% of month income were regarded as being exposed to catastrophic costs. Negative binomial model with robust estimator logit function was used for prediction of catastrophic costs.
Based on data analysis, 42.6% of hospitalized subjects encountered catastrophic costs. Moreover, 11.2% households faced catastrophic cost among all participated households and 39.3% were reported to need inpatient need care. Multivariate regression model showed that age range 40-59 years and being in the lower levels of wealth index were significant predictors of facing catastrophic costs (P < 0.05).
Lack of money is the most important cause of un-seeking care. Hospitalizations due to inpatient care needs, household members aged 40-59 years old, especially with chronic diseases and nonrich status of the household were the highest predictors of facing catastrophic costs. Reducing out-of-pocket costs can increase health care utilization.
保护家庭免受医疗自费导致的贫困风险是卫生系统面临的一项重大挑战。因此，本研究旨在评估伊朗中部一个省份住院和门诊护理的一些医疗支出，并评估住院护理灾难性费用的预测因素。
在这项横断面研究中，通过多阶段抽样方法在伊朗马尔卡齐省选取了760户家庭，并进行访谈以完成一份标准问卷。灾难性费用以从0（无钱支付医疗费用）到100（花费所有收入和财富）的量表进行评估。支付超过家庭财务来源20%或月收入40%的患者被视为面临灾难性费用。使用具有稳健估计对数似然函数的负二项模型来预测灾难性费用。
基于数据分析，42.6%的住院患者遭遇了灾难性费用。此外，在所有参与家庭中，11.2%的家庭面临灾难性费用，据报告39.3%的家庭需要住院护理。多变量回归模型显示，年龄在40 - 59岁以及财富指数处于较低水平是面临灾难性费用的显著预测因素（P < 0.05）。
缺钱是未寻求医疗护理的最重要原因。因住院护理需求而住院、年龄在40 - 岁的家庭成员，尤其是患有慢性病且家庭经济状况不富裕的情况是面临灾难性费用的最高预测因素。降低自费费用可以提高医疗护理利用率。 （注：原文“年龄在40 - 岁”表述有误，推测可能是“40 - 59岁”，译文按此修正）
