Ghiasvand Hesam, Olyaeemanesh Alireza, Majdzadeh Reza, Abdi Zhaleh, Mobinizadeh Mohammadreza
Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
National Institute of Health Research and Health Equity Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
J Res Health Sci. 2018 Jan 3;18(1):e00404.
The financial protection against catastrophic and impoverishing health expenditures is one of the main aspects of the universal health coverage. This study aimed to present a clear picture of the financial protection situation in Iran from 2003-2014.
This is an analytical study on secondary data of Statistical Center of Iran (SCI). The study has some policy implications for policy makers; therefore, it is an applied one.
Data related to the Iranian rural and urban household payments on health expenditures was obtained from annual surveys of the SCI. WHO researchers' approach was used to calculate the Fairness of Financial Contribution Indicator (FFCI), the headcount and overshoot ratios of catastrophic and impoverishing health expenditures. A logistic regression was conducted to identify the determinants of probability of occurrence of catastrophic health expenditure among Iranian households in 2014.
The mean of FFCI for rural and urban households was 0.854 (0.41) and 0.867 (0.32), respectively. The average headcount ratios of catastrophic and impoverishing health expenditures were 1.32% (0.24) and 0.33% (P=0.006) for rural households and 1.4% (0.6) and 0.28% (P=0.001) for urban households. Concerning rural households, the overshoot of catastrophic and impoverishing health expenditures was 14.94% (P=0.001) and 7.22% (0.53); it was 15.59% (1.54) and 7.76% (0.52) for urban households.
No significant and considerable change was found in the headcount ratios of catastrophic and impoverishing health expenditure and in their overshoot or gap amounts. This suggested a lack of well-designed and effective schemes for materializing the financial protection in Iran.
防范灾难性和致贫性医疗支出的财务保护是全民健康覆盖的主要方面之一。本研究旨在清晰呈现2003年至2014年伊朗的财务保护状况。
这是一项基于伊朗统计中心（SCI）二手数据的分析性研究。该研究对政策制定者具有一些政策启示，因此是一项应用型研究。
与伊朗农村和城市家庭医疗支出支付相关的数据来自SCI的年度调查。采用世界卫生组织研究人员的方法计算财务贡献公平性指标（FFCI）、灾难性和致贫性医疗支出的发生率及超支率。进行逻辑回归以确定2014年伊朗家庭发生灾难性医疗支出概率的决定因素。
农村和城市家庭的FFCI均值分别为0.854（0.41）和0.867（0.32）。农村家庭灾难性和致贫性医疗支出的平均发生率分别为1.32%（0.24）和0.33%（P = 0.006），城市家庭分别为1.4%（0.6）和0.28%（P = 0.001）。关于农村家庭，灾难性和致贫性医疗支出的超支率分别为14.94%（P = 0.001）和7.22%（0.53）；城市家庭分别为15.59%（1.54）和7.76%（0.52）。
灾难性和致贫性医疗支出的发生率及其超支或缺口金额未发现显著且可观的变化。这表明伊朗缺乏精心设计且有效的实现财务保护的方案。
