Rezapour Aziz, Ebadifard Azar Farbod, Azami Aghdash Saber, Tanoomand Asghar, Hosseini Shokouh Seyed Morteza, Yousefzadeh Negar, Atefi Manesh Pezhman, Sarabi Asiabar Ali
PhD, Department of Health Economics, School of Health Management and information Sciences& Health management and Economics Research Center &Center of Excellence in Health Management and Economics, Iran University of Medical Sciences. Tehran, Iran.
PhD, Department of Health Education and promotion, School of Health &Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2015 Aug 10;29:246. eCollection 2015.
Households' financial protection against health payments and expenditures and equity in utilization of health care services are of the most important tasks of governments. This study aims to measuring equity in household's health care payments according to fairness in financial contribution (FFC) and Kakwani indices in Tehran-Iran, 2013.
This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200 households. Households were selected using stratified-cluster sampling including typical families who reside in the city of Tehran. The data were analyzed through Excel and Stata v.11software. Recall period for the inpatient care was 1 year and for outpatient1 month.
The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the indicator was ascending by the rise in the ranking of households' financial level. The Kakwani index was estimated to be a negative number (-0.00125) which indicated the descending trend of health financing system. By redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated to be a positive number (0.090555) which indicated the ascending trend of health financing system.
According to this study, the equity indices in health care financing denote injustice and a descending trend in the health care financing system. This finding clearly shows that deliberate policy making in health financing by national health authorities and protecting low-income households against health expenditures are required to improve the equity in health.
家庭抵御医疗支付和支出的经济保护以及医疗服务利用的公平性是政府最重要的任务之一。本研究旨在根据2013年伊朗德黑兰家庭经济贡献公平性(FFC)和卡克瓦尼指数来衡量家庭医疗支付的公平性。
这项横断面研究于2014年进行。研究样本量估计为2200户家庭。采用分层整群抽样方法选取家庭,包括居住在德黑兰市的典型家庭。数据通过Excel和Stata v.11软件进行分析。住院治疗的回忆期为1年,门诊治疗为1个月。
家庭健康融资的FFC指标估计为0.68,该指标的趋势随着家庭经济水平排名的上升而上升。卡克瓦尼指数估计为负数(-0.00125),表明健康融资系统呈下降趋势。通过收入再分配或免除最贫困五分之一人口的医疗支付,卡克瓦尼指数估计为正数(0.090555),表明健康融资系统呈上升趋势。
根据本研究,医疗融资中的公平指数表明存在不公平现象,且医疗融资系统呈下降趋势。这一发现清楚地表明,国家卫生当局需要在医疗融资方面进行审慎的政策制定,并保护低收入家庭免受医疗支出的影响,以提高健康公平性。