为穷人取消用户付费：一项探索伊朗社会健康援助政策的定性研究。
User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran.
机构信息
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada.
出版信息
BMC Health Serv Res. 2022 Feb 24;22(1):250. doi: 10.1186/s12913-022-07629-8.
INTRODUCTION
Removal of user fee for vulnerable people reduces the financial barriers associated with healthcare payments, which, in turn, improves health outcomes and promotes health equity. This study sought to provide policy strategies to reduce user fee at the point of service delivery for the poor in Iran.
METHODS
This is a qualitative study carried out in 2018. The purposive sampling method was applied, and 33 experts with relevant and valuable experiences and maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were used to assure the quality of the results. The data were analyzed based on thematic analysis using the MAXQDA10 software.
RESULTS
The most important issue regarding financial protection against user fee for the poor in Iran is policy integration and cohesion. Differences in access to financial support for user fee coverage among different groups of the poor have led to inequalities in access and financial protection among the poor. The suggested protection policies against the user fee at the point of service delivery in Iran can be categorized into three main categories: 1) basic health social insurance instruments, 2) free health services to the poor outside of the health insurance system, and 3) complementary insurance mechanisms.
CONCLUSION
Implementing a cohesive social assistance policy for all disadvantaged groups is needed to address inequalities in financial protection against user fee payment among the poor in Iran. Reducing user fee through mechanisms such as deductible cap, stop-loss, variable user fee and sliding fee scale can improve financial protection and enhance healthcare utilization among the poor. A user fee exemption is not enough to remove barriers to access to service for the poor, as other costs such as transportation expenditures and informal payments also put financial pressure on them. Therefore, financial support for the poor should be designed in a comprehensive protection package to reduce out-of-pocket payments for healthcare services, and indirect costs associated with healthcare utilization.
简介
为弱势群体免除医疗费用可以减少与医疗支付相关的经济障碍，从而改善健康结果并促进健康公平。本研究旨在为伊朗在服务提供点为贫困人口减免医疗费用提供政策策略。
方法
这是一项 2018 年进行的定性研究。采用了目的抽样法，对 33 名具有相关和宝贵经验且具有最大变异性的专家进行了访谈，以获得代表性和丰富的数据。采用可信度标准来确保结果的质量。使用 MAXQDA10 软件对数据进行基于主题分析的分析。
结果
伊朗针对贫困人口免除医疗费用的财务保护的最重要问题是政策整合和凝聚力。不同贫困群体获得用户费用财务支持的机会不同，导致贫困群体之间在获得和财务保护方面存在不平等。伊朗在服务提供点针对用户费用的建议保护政策可分为三类：1）基本健康社会保险工具，2）在医疗保险体系之外为贫困人口提供免费医疗服务，3）补充保险机制。
结论
需要为所有弱势群体实施协调一致的社会援助政策，以解决伊朗贫困人口在医疗费用支付方面的财务保护不平等问题。通过设置免赔额上限、损失停止、可变用户费用和滑动费用表等机制来降低用户费用，可以提高贫困人口的财务保护水平并增加其对医疗保健的利用。免除用户费用不足以消除贫困人口获得服务的障碍，因为其他费用（如交通支出和非正式支付）也会给他们带来经济压力。因此，应设计全面的保护方案为贫困人口提供财务支持，以减少医疗服务的自付费用和与医疗保健利用相关的间接成本。
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