Moradi Ghobad, Safari Hossein, Piroozi Bakhtiar, Qanbari Laila, Farshadi Salahadin, Qasri Homan, Farhadifar Fariba
Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2017 Aug 2;31:43. doi: 10.14196/mjiri.31.43. eCollection 2017.
One of the main goals of health systems is to protect people against financial risks associated with diseases that can be catastrophic for patients. In 2014, Health Sector Evolution Plan (HSEP) was implemented in Iran; one of the objectives of HSEP was to reduce out-of-pocket payments and provide more financial protection for people. Therefore, the present study aimed at exploring the likelihood of facing catastrophic health expenditures (CHE) among households with members suffering from dialysis, kidney transplant, or multiple sclerosis (MS) after the implementation of HSEP. A total number of 385 households were selected using stratified random sampling and were asked to complete the World Health Survey questionnaire through telephone conversations. As outlined by the World Health Organization (WHO), when household out-of-pocket expense for health services is ≥40% of its capacity to pay, then that household is considered to be facing CHE. Furthermore, determinants of CHE were identified using logistic regression. The percentage of facing catastrophic health care expenditures for households with a MS, dialysis, and kidney transplant patient was 20.6%, 18.7%, and 13.8%, respectively. Results of logistic regression analysis revealed that patient's economic status, level of education, supplementary insurance status, type of disease, multiple members with special diseases in the household, rural residence, use of inpatient, dental, and rehabilitation services were effective factors for determining the likelihood of facing CHE. Despite the implementation of HSEP, the percentage of CHE is still high for households that have members who suffer from special diseases. However, basic health insurance packages should be amended and more cost-sharing exemptions should be granted to provide more financial protection for the vulnerable households.
卫生系统的主要目标之一是保护人们免受与疾病相关的经济风险，这些疾病可能对患者造成灾难性影响。2014年，伊朗实施了《卫生部门发展计划》（HSEP）；HSEP的目标之一是减少自付费用，为人们提供更多经济保护。因此，本研究旨在探讨在HSEP实施后，家庭成员患有透析、肾移植或多发性硬化症（MS）的家庭面临灾难性医疗支出（CHE）的可能性。采用分层随机抽样选取了385户家庭，并通过电话访谈要求他们填写世界卫生调查问卷调查表。正如世界卫生组织（WHO）所概述的，当家庭用于医疗服务的自付费用≥其支付能力的40%时，该家庭即被视为面临CHE。此外，使用逻辑回归确定CHE的决定因素。患有MS、透析和肾移植患者的家庭面临灾难性医疗支出的百分比分别为20.6%、18.7%和13.8%。逻辑回归分析结果显示，患者的经济状况、教育水平、补充保险状况、疾病类型、家庭中有多名特殊疾病成员、农村居住、住院、牙科和康复服务的使用是决定面临CHE可能性的有效因素。尽管实施了HSEP，但对于有特殊疾病成员的家庭，CHE的百分比仍然很高。然而，应修订基本医疗保险套餐，并给予更多费用分摊豁免，以为弱势家庭提供更多经济保护。
