Mohammadzadeh Yousef, Sheikhmali Aysan, Yahyavi Dizaj Jafar, Mosadeghrad Ali Mohammad, Yusefzadeh Hasan, Refah Kahriz Arash
Department of Economics, Faculty of Economics and Management, Urmia University, Urmia, Iran.
Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Cost Eff Resour Alloc. 2023 Aug 14;21(1):54. doi: 10.1186/s12962-023-00460-w.
Iran government implemented the targeted subsidy plan in December 2010 to reduce energy consumption and inequality. In addition, the Health Transformation Plan was implemented by the Ministry of Health to reduce out-of-pocket payments. This study aimed to examine the impact of these two government subsidy programs on equity in health financing.
In this study, data on 528,046 households were collected using household surveys during 14 years (2007-2020). The Fairness in Financial Contribution index and Catastrophic Health Expenditures index were calculated. Also, a Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of the two mentioned policies and other socioeconomic characteristics of households on their exposure to Catastrophic Health Expenditures.
The FFC index was 0.829 and 0.795 respectively in 2007 and 2020. The trend analysis did not show significant changes in the FFC index between 2007 and 2020. TSP and HTP implementations do not reduce households' exposure to CHE significantly. Crowded households with more elder people, belonging to low-income deciles, without houses, and living in rural areas and deprived provinces, are more likely to be at risk of CHE. Health insurance coverage did not protect households from CHE. Highly educated and employed households were exposed to less CHE.
The government subsidy programs have not been effective in improving FFC and reducing CHE indices. None of them has been able to realize the goal of the 6th National Development Plan of reducing CHE to 1%. The government should devise support packages for target households (households with more elderly people, lower incomes, without private houses, crowded, rural, and inhabited in deprived provinces), so they can protect households against CHE. Modifying and improving the quality of insurance coverage is strongly recommended due to its inefficiency.
伊朗政府于2010年12月实施了有针对性的补贴计划，以减少能源消耗和不平等现象。此外，卫生部实施了健康转型计划，以减少自付费用。本研究旨在探讨这两项政府补贴计划对卫生筹资公平性的影响。
在本研究中，通过家庭调查在14年（2007 - 2020年）期间收集了528,046户家庭的数据。计算了财务贡献公平指数和灾难性卫生支出指数。此外，使用Stata V.14应用软件进行逻辑回归模型，以检验上述两项政策以及家庭的其他社会经济特征对其遭受灾难性卫生支出的影响。
2007年和2020年的FFC指数分别为0.829和0.795。趋势分析表明，2007年至2020年期间FFC指数没有显著变化。TSP和HTP的实施并没有显著降低家庭遭受CHE的风险。人口拥挤、老年人较多、属于低收入十分位数、没有住房、生活在农村地区和贫困省份的家庭更有可能面临CHE风险。医疗保险覆盖并不能保护家庭免受CHE影响。受过高等教育和有工作的家庭遭受的CHE较少。
政府补贴计划在改善FFC和降低CHE指数方面没有效果。它们都未能实现第六个国家发展计划将CHE降低到1%的目标。政府应为目标家庭（老年人较多、收入较低、没有私人住房、人口拥挤、农村和居住在贫困省份的家庭）制定支持方案，以便他们能够保护家庭免受CHE影响。由于其效率低下，强烈建议修改和提高保险覆盖质量。
