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伊朗成年残疾人获得医疗服务的经济障碍:全民健康覆盖面临的挑战

Financial Barriers to Access to Health Services for Adult People with Disability in Iran: The Challenges for Universal Health Coverage.

作者信息

Soltani Shahin, Takian Amirhossein, Akbari Sari Ali, Majdzadeh Reza, Kamali Mohammad

机构信息

Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Iran J Public Health. 2019 Mar;48(3):508-515.

Abstract

BACKGROUND

Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran.

METHODS

In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran.

RESULTS

We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD).

CONCLUSION

Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD.

摘要

背景

减少医疗保健获取方面的不平等是所有卫生系统最重要的目标之一。经济障碍在此起着根本性作用。残疾人在获取所需医疗服务时会遇到更多经济障碍。本研究旨在探讨伊朗德黑兰残疾人获取卫生服务障碍的原因。

方法

在这项定性研究中,我们使用半结构化深度访谈收集数据,并通过具有最大变异性的目的抽样选择参与者。2015年9月至2016年5月期间,我们在伊朗德黑兰的不同地点对残疾人、医疗服务提供者和政策制定者进行了56次个人访谈。

结果

我们确定了影响残疾人获取医疗服务的四类经济障碍和八个子类别。四类障碍分别与医疗保险(如牙科、职业治疗和言语治疗等服务缺乏保险覆盖)、可承受性(残疾人和其家庭收入低)、经济支持(如残疾人养老金水平低)和交通成本(残疾人前往医疗设施的交通成本高)有关。

结论

经济问题会导致难以获得医疗服务。为实现全民健康覆盖,政府应减少医疗保险障碍,增加残疾人的就业机会和足够的经济支持。

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