Nemati Esmat, Khezri Ali, Nosratnejad Shirin
Department of Accreditation and Supervision on Treatment, Dezful University of Medical Sciences, Dezful, Iran.
School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran.
Risk Manag Healthc Policy. 2020 Sep 22;13:1677-1685. doi: 10.2147/RMHP.S264943. eCollection 2020.
One of the main objectives of health systems is providing financial protection against out-of-pocket (OOP) health expenditures. According to the 2011 report by the World Health Organization in the Eastern Mediterranean Regional Office (EMRO), a huge portion of health service in Iran is paid OOP, which is around 58% of the total health system expenditure. Furthermore, all over the world, around 25 million households (100 million people) are trapped in poverty as a result of paying health service costs. Therefore, this research was aimed at investigating the OOP and exposure of households with catastrophic health expenditures (CHE) following the implementation of a health transformation plan in Tabriz, Iran.
A descriptive-analytic study was conducted on a cross-sectional basis. The sample included 400 households, who were interviewed using the World Health Survey questionnaire, and then OOP payment and exposure of households to CHE were estimated, and the effective factors on OOP payment and the determinants of CHE were analyzed using a regression model.
After implementing the health transformation plan, the average share of households' OOP payments, toward their ability to pay was 13.2%. In addition, 11.25% of the households were exposed to CHE in Tabriz. The key determinants of OOP were income, dental services, pharmaceuticals, radiology, and physiotherapy. The factors affecting CHE were income, insurance status, marital status, dental services, pharmacy, physiotherapy, and radiological services.
Based on the results of the current study and compared to similar research conducted prior to this plan, it is obvious that the transformation plan was able to achieve its goal in "reducing OOP payments". However, health services such as dental, pharmacy, physiotherapy, and radiology would increase the likelihood of facing OOP payments. These variables should be considered by health policy-makers in order to review and revise the content of recent reform to provide financial protection against OOP for people.
卫生系统的主要目标之一是提供经济保护，以抵御自付医疗费用。根据世界卫生组织东地中海区域办事处（EMRO）2011年的报告，伊朗很大一部分医疗服务是自付费用，约占卫生系统总支出的58%。此外，在全球范围内，约2500万户家庭（1亿人口）因支付医疗服务费用而陷入贫困。因此，本研究旨在调查伊朗大不里士实施卫生改革计划后家庭的自付费用情况以及面临灾难性医疗支出（CHE）的情况。
开展了一项横断面描述性分析研究。样本包括400户家庭，使用世界卫生调查问卷对其进行访谈，然后估算家庭的自付费用以及面临灾难性医疗支出的情况，并使用回归模型分析影响自付费用的有效因素和灾难性医疗支出的决定因素。
实施卫生改革计划后，家庭自付费用占其支付能力的平均比例为13.2%。此外，大不里士有11.25%的家庭面临灾难性医疗支出。自付费用的关键决定因素是收入、牙科服务、药品、放射学和物理治疗。影响灾难性医疗支出的因素是收入、保险状况、婚姻状况、牙科服务、药房、物理治疗和放射学服务。
根据本研究结果并与该计划实施前进行的类似研究相比，显然改革计划能够实现其“减少自付费用”的目标。然而，牙科、药房、物理治疗和放射学等医疗服务会增加面临自付费用的可能性。卫生政策制定者应考虑这些变量，以审查和修订近期改革的内容，为人们提供抵御自付费用的经济保护。
