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确定伊朗哈马丹省家庭医疗保健支付中的公平性

Determining Equity in Household's Health Care Payments in Hamedan Province, Iran.

作者信息

Rezapour Aziz, Arabloo Jalal, Tofighi Shahram, Alipour Vahid, Sepandy Mojtaba, Mokhtari Payam, Ghanbary Abbas

机构信息

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Arch Iran Med. 2016 Jul;19(7):480-7.

Abstract

BACKGROUND

Financial protection of household against the consequences of the health care expenditures is one of the most important functions of health care systems. The objective of this study was to determine the equity in health care payments and determining factors among households in Hamedan, a province in Iran.

METHODS

In this cross-sectional study, 772 families of patients, who were being discharged from hospitals in Hamedan, were selected for study by using a stratified random sampling method. Required data regarding households' health and non-health expenditures were collected through World Health Organization standard questionnaire by interviews and observation method.

RESULTS

According to the findings, 20.7% of households experienced catastrophic health expenditure. The incidence of impoverishment due to out-of-pocket payments for health care was 2.8% among studied households. The highest incidence rate of out-of-pocket health payment indices occurred in the first quintile (poorest or Q1). Variables such as having members under 6 years or over 60 years in household, household size, employment of household head, households' income quintile, existence of the disabled member in households and the education level of the household's head are the most important factors that affect the incidence of out-of-pocket health payment indices.

CONCLUSION

There is considerable inequity in health care financing as well as households' health payments. This requires designing and implementing the operative and protective programs for understanding the important factors that affect equity in health financing, especially for poor households, against the unexpected health expenditures through the health care system.

摘要

背景

家庭抵御医疗保健支出后果的经济保护是医疗保健系统最重要的功能之一。本研究的目的是确定伊朗哈马丹省家庭在医疗保健支付方面的公平性及其决定因素。

方法

在这项横断面研究中,采用分层随机抽样方法,选取了772户从哈马丹医院出院的患者家庭进行研究。通过世界卫生组织标准问卷,采用访谈和观察法收集有关家庭健康和非健康支出的所需数据。

结果

根据研究结果,20.7%的家庭经历了灾难性医疗支出。在研究家庭中,因自付医疗费用导致贫困的发生率为2.8%。自付医疗支付指数的最高发生率出现在第一个五分位数(最贫困或Q1)。家庭中有6岁以下或60岁以上成员、家庭规模、户主就业情况、家庭收入五分位数、家庭中是否存在残疾成员以及户主的教育水平等变量是影响自付医疗支付指数发生率的最重要因素。

结论

医疗保健融资以及家庭医疗支付方面存在相当大的不公平。这需要设计和实施有效的保护方案,以了解影响医疗融资公平性的重要因素,特别是针对贫困家庭,使其能够抵御通过医疗保健系统产生的意外医疗支出。

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