Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
J Prev Med Public Health. 2022 Jul;55(4):379-388. doi: 10.3961/jpmph.22.123. Epub 2022 Jun 27.
Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.
This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.
Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.
In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.
纵观历史，社会一直受到不平等的影响。许多研究更广泛地探讨了这一主题，但只有少数研究调查了医疗支出自付额（OHP）方面的不平等。本研究衡量了伊朗家庭的 OHP 不平等趋势。
本研究使用了伊朗统计中心关于伊朗家庭收入和支出的数据。该分析包括 1984 年至 2019 年 36 年间的 995300 户家庭。计算了伊朗 OHP 的基尼系数、阿特金森指数和泰尔指数。
伊朗家庭平均 OHP 从 1984 年的 33 美元增加到 2019 年的 47 美元。在这 36 年期间，OHP 的平均±标准偏差基尼系数为 0.73±0.04，阿特金森和泰尔指数分别为 0.68±0.05 和 1.14±0.29。门诊诊断服务、医疗辅助配件、医院住院服务和戒毒 OHP 子分类的基尼系数分别为 0.70、0.61、0.84 和 0.64。
在这项研究中，我们仔细研究了伊朗家庭 OHP 不平等的趋势。在过去的四十年中，OHP 的不平等略有下降。对不同亚组趋势的分析表明，富裕家庭（如有保险覆盖的家庭和收入较高的十位数家庭）经历了更高的不平等。因此，医疗支出不平等程度较低可能与伊朗医疗服务获取受限有关。
