伊朗卫生转型计划在多大程度上解决了伊朗医疗保健融资中的不平等问题？
To what extent has the Iranian Health Transformation Plan addressed inequality in healthcare financing in Iran?
机构信息
Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
出版信息
Int J Equity Health. 2023 Apr 6;22(1):62. doi: 10.1186/s12939-023-01880-z.
BACKGROUND
One of the major goals of health systems is providing a financing strategy without inequality; this has a significant impact on people's access to healthcare. The present study aimed to investigate the inequality in households' financial contribution (HFC) to health expenditure both before and after the implementation of the Iranian Health Transformation Plan (HTP) in 2014.
METHODS
This study is a secondary analysis of two waves of a national survey conducted in Iran. The data were collected from the Households Income and Expenditure Survey in 2013 and 2015. The research sample included 76,195 Iranian households. The inequality in households' financial contributions to the health system was assessed using the Gini coefficient, and the concentration index (CI). In addition, by using econometric modeling, the relationship between the implementation of the HTP and inequality in HFC was studied. The households' financial contribution included healthcare and health insurance prepayments.
RESULTS
The Gini coefficient values were 0.67 and 0.65 in 2013 and 2015, respectively, indicating a medium degree of inequality in HFC in both years. The CI values were 0.54 and 0.56 in 2013 and 2015, respectively, suggesting that inequalities in HFC were in favor of higher income quintiles in the years before and after the implementation of the HTP. Regression analysis showed that households with a female head, with an unemployed head, or with a head having income without a job were contributing more to financing health expenditure. The presence of a household member over the age of 65 was associated with a higher level of HFC. The implementation of the HTP had a negative relationship with the HFC.
CONCLUSION
The HTP, aiming to address inequality in the financing system, did not achieve the intended goal as expected. The implementation of the HTP neglected certain factors at the household level, such as the presence of family members older than the age of 65, a female household head, and unemployment. This resulted in a failure to reduce the inequality of the HFC. We suggest that, in the future, policymakers take into account factors at the household level to reduce inequality in the HFC.
背景
卫生系统的主要目标之一是提供一个没有不平等的筹资策略；这对人们获得医疗保健的机会有重大影响。本研究旨在调查 2014 年伊朗卫生转型计划（HTP）实施前后家庭对卫生支出的财务贡献（HFC）不平等情况。
方法
这是对伊朗进行的两次全国调查的二次分析。数据来自 2013 年和 2015 年的家庭收入和支出调查。研究样本包括 76195 户伊朗家庭。使用基尼系数和集中指数（CI）评估家庭对卫生系统财务贡献的不平等程度。此外，通过使用计量经济学模型，研究了 HTP 的实施与 HFC 不平等之间的关系。家庭的财务贡献包括医疗保健和健康保险预付款。
结果
2013 年和 2015 年的基尼系数值分别为 0.67 和 0.65，表明这两年 HFC 存在中度不平等。2013 年和 2015 年的 CI 值分别为 0.54 和 0.56，表明在 HTP 实施前后，HFC 不平等有利于收入较高的五分位数。回归分析表明，户主为女性、户主失业或户主收入无工作的家庭，对融资卫生支出的贡献更大。家庭中有 65 岁以上的成员与更高水平的 HFC 相关。HTP 的实施与 HFC 呈负相关。
结论
HTP 旨在解决融资系统中的不平等问题，但并未达到预期目标。HTP 实施忽略了家庭层面的某些因素，如家庭中有 65 岁以上的成员、户主为女性和失业，导致 HFC 不平等状况没有得到改善。我们建议，未来政策制定者应考虑家庭层面的因素，以减少 HFC 的不平等。
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