Mohammadi Seyed-Farzad, Alinia Cyrus, Ghaderi Ebrahim, Lashay Alireza, Jabbarvand Mahmoud, Ashrafi Elham, Nourmohammadi Naser, Shahraz Saeid
Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
Iran J Public Health. 2019 Jul;48(7):1301-1309.
Due to lack of information about ophthalmic economics in Iran, health policy makers unable to distribute resources optimally in terms of efficiency and equity. Therefore, we estimated the total and eye care utilization, out-of-pocket expenditures, and its association with social determinants of health in Iran in 2015.
A multi-stage population-based, cross-sectional study in a random sample aged 50 yr or older in Kurdistan Province, Northwest Iran was used. The utilization rate of eye and general health care and related out-of-pocket expenditures was estimated during the recent last six months. To find the association between social factors and care out-of-pocket expenditures, we used a Heckman two-step regression model.
About 81% and 37% of participants were utilized the health and ophthalmic services, respectively. Statistically significant lower ophthalmic utilization rates were observed among men, middle-aged population, illiterate participants, rural residents, daily-paid workers, and the poorest participants. The average of vision and total health-related out-of-pocket expenditures among those used these services have estimated as US$43.7 (SE: 2.6) and US$439.9 (SE: 22.8), respectively. The highest (US$ 396.6) and lowest (US$ 10.4) ophthalmic out-of-pocket costs were related to patients with Glaucoma and Central Nervous System abnormalities, respectively. Multivariate analyses confirmed an unequal probability of having the ophthalmic out-of-pocket expenditures among different subgroups especially in favor of females, older, and those with more severe visual impairment.
Ophthalmic disorders reconstituted about 10% of all health services OOP expenditures on average among individuals older than 50 yr.
由于伊朗缺乏眼科经济学方面的信息，卫生政策制定者无法在效率和公平方面优化资源分配。因此，我们估算了2015年伊朗的总体医疗和眼科医疗利用率、自付费用及其与健康社会决定因素的关联。
采用基于多阶段人群的横断面研究，对伊朗西北部库尔德斯坦省50岁及以上的随机样本进行研究。估算了最近六个月内眼科和一般医疗保健的利用率以及相关自付费用。为了找出社会因素与医疗自付费用之间的关联，我们使用了Heckman两步回归模型。
分别约有81%和37%的参与者使用了医疗和眼科服务。在男性、中年人群、文盲参与者、农村居民、日薪工人和最贫困参与者中，观察到眼科利用率在统计学上显著较低。使用这些服务的人群中，视力和与健康相关的总体自付费用平均估计分别为43.7美元（标准误：2.6）和439.9美元（标准误：22.8）。眼科自付费用最高（396.6美元）和最低（10.4美元）分别与青光眼患者和中枢神经系统异常患者有关。多变量分析证实，不同亚组之间发生眼科自付费用的概率不平等，尤其是有利于女性、老年人以及视力损害更严重的人群。
在50岁以上的个体中，眼科疾病平均约占所有医疗服务自付费用的10%。
