Doshmangir Leila, Yousefi Mahmood, Hasanpoor Edris, Eshtiagh Behzad, Haghparast-Bidgoli Hassan
1Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran.
2Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
Cost Eff Resour Alloc. 2020 May 15;18:17. doi: 10.1186/s12962-020-00212-0. eCollection 2020.
Catastrophic health expenditures (CHE) are of concern to policy makers and can prevent individuals accessing effective health care services. The exposure of households to CHE is one of the indices used to evaluate and address the level of financial risk protection in health systems, which is a key priority in the global health policy agenda and an indicator of progress toward the UN Sustainable Development Goal for Universal Health Coverage. This study aims to assess the CHE at population and disease levels and its influencing factors in Iran.
This study is a systematic review and meta-analysis. The following keywords and their Persian equivalents were used for the review: Catastrophic Health Expenditures; Health Equity; Health System Equity; Financial Contribution; Health Expenditures; Financial Protection; Financial Catastrophe; and Health Financing Equity. These keywords were searched with no time limit until October 2019 in PubMed, Web of Science, Scopus, ProQuest, ScienceDirect, Embase, and the national databases of Iran. Studies that met a set of inclusion criteria formed part of the meta-analysis and results were analyzed using a random-effects model.
The review identified 53 relevant studies, of which 40 are conducted at the population level and 13 are disease specific. At the population level, the rate of CHE is 4.7% (95% CI 4.1% to 5.3%, n = 52). Across diseases, the percentage of CHE is 25.3% (95% CI 11.7% to 46.5%, n = 13), among cancer patients, while people undergoing dialysis face the highest percentage of CHE (54.5%). The most important factors influencing the rate of CHE in these studies are health insurance status, having a household member aged 60-65 years or older, gender of the head of household, and the use of inpatient and outpatient services.
The results suggest that catastrophic health spending in Iran has increased from 2001 to 2015 and has reached its highest levels in the last 5 years. It is therefore imperative to review and develop fair health financing policies to protect people against financial hardship. This review and meta-analysis provides evidence to help inform effective health financing strategies and policies to prioritise high-burden disease groups and address the determinants of CHE.
灾难性卫生支出（CHE）是政策制定者关注的问题，可能会阻碍个人获得有效的医疗服务。家庭面临灾难性卫生支出是用于评估和解决卫生系统财务风险保护水平的指标之一，这是全球卫生政策议程的关键优先事项，也是朝着联合国全民健康覆盖可持续发展目标取得进展的一个指标。本研究旨在评估伊朗人群和疾病层面的灾难性卫生支出及其影响因素。
本研究是一项系统评价和荟萃分析。以下关键词及其波斯语对应词用于该评价：灾难性卫生支出；健康公平；卫生系统公平性；财务贡献；卫生支出；财务保护；财务灾难；以及卫生筹资公平性。这些关键词在PubMed、科学网、Scopus、ProQuest、ScienceDirect、Embase和伊朗国家数据库中进行无时间限制的检索，直至2019年10月。符合一组纳入标准的研究构成荟萃分析的一部分，并使用随机效应模型分析结果。
该评价共识别出53项相关研究，其中40项在人群层面开展，13项针对特定疾病。在人群层面，灾难性卫生支出发生率为4.7%（95%置信区间4.1%至5.3%，n = 52）。在各类疾病中，癌症患者的灾难性卫生支出百分比为25.3%（95%置信区间11.7%至46.5%，n = 13），而接受透析的人群面临的灾难性卫生支出百分比最高（54.5%）。这些研究中影响灾难性卫生支出发生率的最重要因素是健康保险状况、有60 - 65岁及以上家庭成员、户主性别以及住院和门诊服务的使用情况。
结果表明，伊朗的灾难性卫生支出在2001年至2015年期间有所增加，并在过去5年达到最高水平。因此，必须审查和制定公平的卫生筹资政策，以保护人们免受经济困难。本评价和荟萃分析提供了证据，有助于为有效的卫生筹资战略和政策提供信息，以优先考虑高负担疾病群体并解决灾难性卫生支出的决定因素。
