Assari Arani Abbas, Atashbar Tohid, Antoun Joseph, Bossert Thomas
Dept. of Development and Planning, Faculty of Management and Economics, Tarbriat Modarres University, Tehran, Iran.
Dept. of Health Economics, Faculty of Management and Economics, Tarbriat Modarres University, Tehran, Iran.
Iran J Public Health. 2018 Mar;47(3):390-396.
Two years after the implementation of the Health Sector Evolution Plan (HSEP), this study evaluated the effects of the plan on health equity indices.
The main indices assessed by the study were the Out-of-Pocket (OOP) health expenditures, the Fairness in Financial Contribution (FFC) to the health system index, the index of households' Catastrophic Health Expenditure (CHE) and the headcount ratio of Impoverishing Health Expenditure (IHE).
The per capita share of costs for total health services has been decreased. The lowered costs have been more felt in rural areas, generally due to sharp decrease in inpatient costs. Per capita pay for outpatient services is almost constant or has slightly increased. The reform plan has managed to improve households' Catastrophic Health Expenditure (CHE) index from an average of 2.9% before the implementation of the plan to 2.3% after the plan. The Fairness in Financial Contribution (FFC) to the health system index has worsened from 0.79 to 0.76, and the headcount ratio of Impoverishing Health Expenditure (IHE) index deteriorated after the implementation of plan from 0.34 to 0.50.
Considerable improvement, in decreasing the burden of catastrophic hospital costs in low income strata which is about 26% relative to the time before the implementation of the plan can be regarded as the main achievement of the plan, whereas the worsening in the headcount ratio of IHE and FFC are the equity bottlenecks of the plan.
在卫生部门发展计划（HSEP）实施两年后，本研究评估了该计划对卫生公平指数的影响。
该研究评估的主要指标包括自付医疗费用、对卫生系统的财务贡献公平性（FFC）指数、家庭灾难性卫生支出（CHE）指数以及致贫卫生支出（IHE）的人口比例。
卫生服务总成本的人均费用份额有所下降。农村地区费用降低更为明显，这通常归因于住院费用的大幅下降。门诊服务的人均费用几乎保持不变或略有增加。改革计划成功将家庭灾难性卫生支出（CHE）指数从计划实施前的平均2.9%降至计划实施后的2.3%。对卫生系统的财务贡献公平性（FFC）指数从0.79降至0.76，致贫卫生支出（IHE）指数的人口比例在计划实施后从0.34恶化至0.50。
该计划的主要成就是在减轻低收入阶层灾难性住院费用负担方面取得了显著改善，相对于计划实施前约降低了26%，而IHE和FFC人口比例的恶化是该计划的公平性瓶颈。
