Ahmadi Faranak, Farrokh-Eslamlou Hamidreza, Yusefzadeh Hasan, Alinia Cyrus
Department of Health Management and Economics, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
Reproductive Health Research Centre, School of Public Health, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
BMC Health Serv Res. 2021 Apr 9;21(1):327. doi: 10.1186/s12913-021-06330-6.
Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran.
In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting these indicators, we performed the two different multivariate logistic regression models.
This study finds that each patient had a monthly average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed 13.77% of their households to CHE. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them forced to sell their assets, borrow, or take a bank loan.
The patients in lower SES quintiles can be protected from impoverishing and catastrophic health spending by expanding insurance coverage, providing financial risk protection programs, and increasing access to quality and effective public sector services. Alongside, expanding inpatient coverage and adding drug benefits for the poor can significantly decrease their OOP payments.
乳腺癌是伊朗女性中最常见的癌症，给家庭带来了沉重的经济负担。本研究计算了伊朗乳腺癌患者的自付费用（OOP）、灾难性卫生支出（CHE）以及致贫性卫生支出。
在这项横断面家庭研究中，2019年通过面对面访谈和让138名乳腺癌女性患者填写问卷，获取了乳腺癌的临床和财务信息以及家庭信息（支出和收入）。我们应用40%、20%和10%这三个非食品支出阈值来定义灾难性卫生支出。疾病费用包括定期就诊、诊断服务、住院护理、治疗和康复服务、家庭护理及非正式护理。根据成人当量值标准化的每月消费支出，将家庭划分为社会经济地位五等份。为确定影响这些指标的因素，我们进行了两种不同的多变量逻辑回归模型分析。
本研究发现，每位患者每月为所需求的服务平均自付费用为97.87美元，导致5.07%的家庭陷入贫困，13.77%的家庭面临灾难性卫生支出。这些指标主要集中在贫困人口中，因为他们将微薄收入的很大一部分用于购买所需服务，为此，他们中的大多数人被迫出售资产、借贷或申请银行贷款。
通过扩大保险覆盖范围、提供金融风险保护计划以及增加获得优质高效公共部门服务的机会，可以保护社会经济地位较低五等份的患者免于陷入贫困和承担灾难性卫生支出。此外，扩大住院保险覆盖范围并为贫困人口增加药品福利可显著降低他们的自付费用。
