伊朗医改计划前后的自付费用和非正式支付：来自伊朗库尔德斯坦医院的证据。
Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran.
机构信息
Department of Health Services Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Int J Health Policy Manag. 2017 Oct 1;6(10):573-586. doi: 10.15171/ijhpm.2017.16.
BACKGROUND
One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran.
METHODS
This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples t test.
RESULTS
The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P<.05). The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase.
CONCLUSION
It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in Kurdistan province.
背景
伊朗卫生转型计划（HTP）的目标之一是降低住院服务的自付费用并消除非正式支付。HTP 分三个阶段：第一阶段（2014 年 5 月 5 日启动）专注于降低住院服务的自付费用；第二阶段（2014 年 5 月 22 日启动）专注于初级保健（PHC），第三阶段利用卫生服务的更新相对价值单位（2014 年 9 月 29 日启动），专注于消除非正式支付。本研究旨在确定伊朗库尔德斯坦省 HTP 前后住院服务的自付费用和向医生支付非正式现金的频率。
方法
这项准实验研究采用多阶段抽样方法选择和评估了库尔德斯坦省 265 名出院患者。该研究包括三个阶段（HTP 之前、HTP 第一阶段之后和 HTP 第三阶段之后）。部分数据是使用医院信息系统表格收集的，其余数据是使用问卷收集的。数据采用 Fisher 确切检验、逻辑回归和独立样本 t 检验进行分析。
结果
HTP 之前、HTP 第一阶段之后和 HTP 第三阶段之后，隶属于卫生部和教育部（MoHME）的医院的平均自付费用分别为 59.4 美元、17.6 美元和 14.3 美元，隶属于社会保障组织（SSO）的医院的平均自付费用分别为 39.6 美元、33.7 美元和 13.7 美元，私立医院的平均自付费用分别为 153.3 美元、188.7 美元和 66.4 美元。在隶属于 SSO 和 MoHME 的医院中，HTP 前和 HTP 后第三阶段的平均自付费用之间存在显著差异（P<.05）。隶属于 MoHME、SSO 和私营部门的医院在 HTP 之前向医生支付非正式款项的比例分别为 4.5%、8.1%和 12.5%，在 HTP 第一阶段之后分别为 0.0%、7.1%和 10.0%。与 HTP 之前的时间相比，第三阶段后没有报告非正式支付。
结论
HTP 的实施似乎降低了住院服务的自付费用，并在库尔德斯坦省消除了向医生支付的非正式款项。
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