Mirzaei Abasat, Joshani-Kheibari Morteza, Esmaeili Reza
Department of Health Care Management, Faculty of Health, Tehran Medical Science, Islamic Azad University, Tehran, Iran.
Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical sciences, Islamic Azad University, Tehran, Iran.
Med J Islam Repub Iran. 2023 Feb 22;37:11. doi: 10.47176/mjiri.37.11. eCollection 2023.
Health and economy has substantially been influenced by the coronavirus disease 2019 (COVID-19) pandemic. Because of these impacts, household financial contribution to health system is likely to be changed. This study aimed to compare the distribution of household financial contributions before and during the COVID-19 epidemic.
This is a cross-sectional study. The data were obtained from Iran's Households Income and Expenditure Survey as a national representative survey and included 38,328 households in 2019 (before COVID-19) and 37,577 households in 2020 (during COVID-19 pandemic). The household expenditures deflated according to the Consumer Price Index. The indices of households' out-of-pocket Payments (OPP), catastrophic health expenditures (CHE), and impoverishment were calculated based on a standard methodology. Data analysis was done using an Excel-based software.
The households' total expenditures declined for both urban and rural areas during the COVID-19 outbreak. Meanwhile, health expenditure experienced a negative growth rate for urban and rural households at -25.75% and -15.47%, respectively. The average per capita of OOP annually was 1,220,416 ($41.086 PPP) Rials for urban households and 1,017,760 Rials ($34.263 PPP) for rural households in 2020 (the era of COVID-19), which had dropped -30% and -16%, respectively, relative to 2019 (before COVID-19). The proportional share of health service types from the total health expenditure did not change importantly after the onset of COVID-19. The incidence of CHE and impoverishment due to health payments reduced after the onset of COVID-19.
The households' health expenditures changed considerably during the COVID-19 pandemic and these changes were the same for the urban and rural areas. Despite COVID-19 multi-faceted shocks, the findings of this study showed a slight decline in the incidence of CHE and impoverishment caused by health expenditures. It might be due to forgone health services during the COVID-19 pandemic. Data from these household surveys have some limits to depicting the real effects of this crisis.
2019年冠状病毒病（COVID-19）大流行对健康和经济产生了重大影响。由于这些影响，家庭对卫生系统的经济贡献可能会发生变化。本研究旨在比较COVID-19疫情之前和期间家庭经济贡献的分布情况。
这是一项横断面研究。数据来自伊朗家庭收入与支出调查，该调查具有全国代表性，包括2019年（COVID-19之前）的38328户家庭和2020年（COVID-19大流行期间）的37577户家庭。家庭支出根据消费价格指数进行了平减。家庭自付费用（OPP）、灾难性卫生支出（CHE）和贫困指数是根据标准方法计算得出的。数据分析使用基于Excel的软件完成。
在COVID-19疫情爆发期间，城乡家庭的总支出均有所下降。与此同时，城乡家庭的卫生支出增长率均为负，分别为-25.75%和-15.47%。2020年（COVID-19时期）城市家庭的人均年度自付费用平均为1220416里亚尔（购买力平价41.086美元），农村家庭为1017760里亚尔（购买力平价34.263美元），相对于2019年（COVID-19之前）分别下降了30%和16%。COVID-19爆发后，各类卫生服务在总卫生支出中的比例份额没有发生重大变化。COVID-19爆发后，因卫生支付导致的CHE和贫困发生率有所降低。
在COVID-19大流行期间，家庭卫生支出发生了相当大的变化，城乡地区的变化情况相同。尽管COVID-19带来了多方面的冲击，但本研究结果显示，因卫生支出导致的CHE和贫困发生率略有下降。这可能是由于COVID-19大流行期间放弃了一些卫生服务。这些家庭调查数据在描述这场危机的实际影响方面存在一些局限性。
