Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IR, Iran.
Int J Equity Health. 2019 Jun 17;18(1):92. doi: 10.1186/s12939-019-0963-9.
Fair financial contribution in healthcare financing is one of the main goals and challengeable subjects in the evaluation of world health system functions. This study aimed to investigate the equity in healthcare financing in Shiraz, Iran in 2018.
This was a cross- sectional survey conducted on the Shiraz, Iran households. A sample of 740 households (2357 persons) was selected from 11 municipal districts using the multi-stage sampling method (stratified sampling method proportional to size, cluster sampling and systematic random sampling methods). The required data were collected using the Persian format of "World Health Survey" questionnaire. The collected data were analyzed using Stata14.0 and Excel 2007. The Gini coefficient and concentration and Kakwani indices were calculated for health insurance premiums (basic and complementary), inpatient and outpatient services costs, out of pocket payments and, totally, health expenses.
The Gini coefficient was obtained based on the studied population incomes equal to 0.297. Also, the results revealed that the concentration index and Kakwani index were, respectively, 0.171 and - 0.125 for basic health insurance premiums, 0.259 and - 0.038 for health insurance complementary premiums, 0.198 and - 0.099 for total health insurance premiums, 0.126 and - 0.170 for outpatient services costs, 0.236 and - 0.061 for inpatient services costs, 0.174 and - 0.123 for out of pocket payments (including the sum of costs related to the inpatient and outpatient services) and 0.185 and - 0.112 for the health expenses (including the sum of out of pocket payments and health insurance premiums).
The results showed that the healthcare financing in Shiraz, Iran was regressive and there was vertical inequity and, accordingly, it is essential to making more efforts in order to implement universal insurance coverage, redistribute incomes in the health sector to support low-income people, strengthening the health insurance schemes, etc.
公平的财政贡献是医疗保健融资的主要目标之一，也是评估世界卫生系统功能的具有挑战性的课题。本研究旨在探讨 2018 年伊朗设拉子医疗保健融资的公平性。
这是一项横断面调查，对伊朗设拉子的家庭进行了调查。采用多阶段抽样法（分层抽样法、比例规模、聚类抽样和系统随机抽样法）从 11 个市区抽取了 740 户家庭（2357 人）作为样本。使用“世界卫生调查”问卷的波斯语格式收集所需数据。使用 Stata14.0 和 Excel 2007 分析收集的数据。计算了医疗保险费（基本和补充）、住院和门诊服务费用、自付费用以及总医疗费用的基尼系数、集中和 Kakwani 指数。
根据研究人群的收入，Gini 系数等于 0.297。此外，结果表明，基本医疗保险费的集中指数和 Kakwani 指数分别为 0.171 和-0.125，补充医疗保险费为 0.259 和-0.038，总医疗保险费为 0.198 和-0.099，门诊服务费用为 0.126 和-0.170，住院服务费用为 0.236 和-0.061，自付费用（包括与门诊和住院服务相关的费用之和）为 0.174 和-0.123，总医疗费用（包括自付费用和医疗保险费）为 0.185 和-0.112。
结果表明，伊朗设拉子的医疗保健融资是倒退的，存在纵向不公平，因此，必须努力实现全民保险覆盖，在卫生部门重新分配收入以支持低收入人群，加强医疗保险计划等。
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