解释伊朗健康转型计划实施后城乡地区灾难性医疗支出中的社会经济不平等差异。
Explaining Socioeconomic Inequality Differences in Catastrophic Health Expenditure Between Urban and Rural Areas of Iran After Health Transformation Plan Implementation.
作者信息
Kazemi-Karyani Ali, Woldemichael Abraha, Soofi Moslem, Karami Matin Behzad, Soltani Shahin, Yahyavi Dizaj Jafar
机构信息
Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
出版信息
Clinicoecon Outcomes Res. 2020 Nov 11;12:669-681. doi: 10.2147/CEOR.S261520. eCollection 2020.
OBJECTIVE
Ensuring fair financial contribution is one of the main goals of the Health Transformation Plan (HTP) of Iran. This study aims to estimate socioeconomic inequality differences in catastrophic health expenditure (CHE) between urban and rural areas of Iran after the implementation of the HTP during 2017.
MATERIALS AND METHODS
Data from a representative survey of households' income and xpenditure from the Iran Statistical Center (ISC) were used for the analysis. We applied the World Health Organization (WHO) cut-off of 40% payment for CHE, and Wagstaff's normalized concentration index () to measure and decompose the inequality. Also, Blinder-Oaxaca decomposition analysis was used to decompose contributors of inequality differences between rural and urban areas.
RESULTS
The overall incidence of CHE among Iranian households during the year 2017 was 3.32% with a standard deviation (SD) of 17.91%, and the mean (SD) levels of CHE in rural and urban areas of Iran were 4.37% (20.45%) and 2.97% (16.99%), respectively. The aggregate socioeconomic status (SES)-related inequality in CHE was significantly (<0.001) different from zero (=-0.238) and there was a significant (<0.05) difference between rural (=-0.150) and urban (=0.218) areas. SES was the highest contributor to inequality in both rural (130.09) and urban (144.17) areas. The Blinder-Oaxaca decomposition revealed that SES (175.01%) followed by outpatient services (120.29%) were the main contributors to differences in inequality in rural and urban areas. Sex (-101.42%) and health insurance coverage were among negative contributors to this inequality difference.
CONCLUSION
Our findings revealed a significant pro-rich inequality in CHE. Also, some variables, such as sex and region, made different contributions in rural and urban areas. However, SES, itself, made the highest contribution in both areas and explained the greatest share of difference in inequality between the two areas. This issue calls for revision of the HTP to further address the risk of CHE and socioeconomic disparity among Iranian households, especially those with lowSES.
目的
确保公平的财政贡献是伊朗健康转型计划（HTP）的主要目标之一。本研究旨在估计2017年HTP实施后伊朗城乡地区灾难性卫生支出（CHE）的社会经济不平等差异。
材料与方法
分析采用了来自伊朗统计中心（ISC）的具有代表性的家庭收入和支出调查数据。我们应用世界卫生组织（WHO）关于CHE支付40%的临界值，以及瓦格斯塔夫的标准化集中指数（）来衡量和分解不平等。此外，使用布林德-奥克分解分析来分解城乡地区不平等差异的贡献因素。
结果
2017年伊朗家庭中CHE的总体发生率为3.32%，标准差（SD）为17.91%，伊朗农村和城市地区CHE的平均（SD）水平分别为4.37%（20.45%）和2.97%（16.99%）。CHE中与社会经济地位（SES）相关的总体不平等显著（<0.001）异于零（=-0.238），农村（=-0.150）和城市（=0.218）地区之间存在显著（<0.05）差异。SES是农村（130.09）和城市（144.17）地区不平等的最大贡献因素。布林德-奥克分解显示，SES（175.01%）其次是门诊服务（120.29%）是城乡地区不平等差异的主要贡献因素。性别（-101.42%）和医疗保险覆盖情况是这种不平等差异的负面贡献因素。
结论
我们的研究结果显示CHE中存在显著的有利于富人的不平等。此外，一些变量，如性别和地区，在农村和城市地区的贡献不同。然而，SES本身在两个地区的贡献最大，并解释了两个地区不平等差异的最大份额。这个问题要求修订HTP，以进一步解决伊朗家庭，特别是低SES家庭的CHE风险和社会经济差距。
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