Etemadi Manal, Shiri Mohammad, Rostami Elham, Mohseni Mohammad, Seyedi Masumeh
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Statistical Research and Training Center of Iran, Tehran, Iran.
J Educ Health Promot. 2019 Dec 31;8:243. doi: 10.4103/jehp.jehp_285_19. eCollection 2019.
Protection against financial risks is one of the important goals of the health system. The present study aims to determine the rate of exposure to catastrophic expenditures in the insured inpatients.
The present study was cross-sectional one which is conducted in 2016. The statistical population comprised all the insured patients presenting to a private hospital in Qom who presented to the hospital within 4 months from December 2015 to March 2016. Random convenience sampling method was used, and the sample size was estimated at 267 people using Cochran formula. A questionnaire was employed for data gathering. Data were analyzed using Chi-square test and logistic regression using SPSS software version 20.
Patients exposed to catastrophic expenditures of treatment accounted for the 54.8% of the cases. The highest rate of being exposed to the catastrophic expenditures was related to the insured patients of the Universal Health Insurance Fund (UHIF). People with rural insurance, on average, paid the highest cost of treatment in the hospital. The surgical ward and critical care unit accounted for the biggest percentage of the patients who incurred catastrophic expenditures. Being rural, longer length of stay, lower education of the head of the household, lack of supplementary insurance coverage, and being in UHIF coverage have a substantial relationship with being exposed to catastrophic expenditures.
The socioeconomic status of the insured people in the UHIF and the Rural Insurance Fund was worse than other funds in terms of less utilization and higher rate of exposure to catastrophic expenditures, and this issue requires the adoption of specific targeted policies for these groups in respect with reducing out-of-pocket payments through mechanism such as stepwise copayments, maximum out-of-pocket limit, fee exemptions or waiver and providing supplementary insurance to reduce the exposure to catastrophic expenditures.
防范财务风险是卫生系统的重要目标之一。本研究旨在确定参保住院患者中发生灾难性支出的比例。
本研究为2016年开展的横断面研究。统计人群包括2015年12月至2016年3月4个月内在库姆一家私立医院就诊的所有参保患者。采用随机便利抽样法，使用 Cochr an公式估计样本量为267人。采用问卷收集数据。使用SPSS 20版软件进行卡方检验和逻辑回归分析数据。
面临灾难性治疗支出的患者占病例的54.8%。面临灾难性支出比例最高的是全民健康保险基金（UHIF）的参保患者。农村保险参保者平均支付的住院治疗费用最高。外科病房和重症监护病房中发生灾难性支出的患者比例最大。农村户籍、住院时间较长、户主教育程度较低、缺乏补充保险覆盖以及参加UHIF保险与发生灾难性支出有密切关系。
就利用率较低和面临灾难性支出的比例较高而言，UHIF和农村保险基金参保人员的社会经济状况比其他基金参保人员更差，这一问题需要针对这些群体采取具体的针对性政策，通过逐步共付、最高自付限额、费用豁免或减免等机制减少自付费用，并提供补充保险以降低面临灾难性支出的风险。
