Khatooni Elham, Ahmadnezhad Elham, Olyaeemanesh Alireza, Majdzadeh Reza
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Public Health. 2023 Dec;52(12):2643-2650. doi: 10.18502/ijph.v52i12.14325.
In May 2014, the Iranian government announced it would cover all uninsured Iranians. Despite free-of-charge insurance, the studies found that the coverage still needed to be completed (93%). This study aimed to understand why certain population groups remain without insurance despite the accessibility of free-of-charge coverage. This issue is not unique to Iran; it is prevalent in many other countries where, despite free coverage, not all individuals avail themselves of it, thereby exposing themselves to risks.
In a matched case-control study, 89 non-insured patients were compared with 178 hospital-based controls with health insurance (2:1). The samples were recruited at one of the leading public hospitals in the country (Imam Khomeini Hospital Complex in Tehran) in 2019. Two insured controls were selected and matched for age (± five years) and sex for each person without insurance. A conditional logistic regression was performed to assess the magnitude of effects and the goodness of fit test used to examine the model.
Unemployment (Odds Ratio (OR)=8.33, 95% Confidence interval (CI): 1.05-50.0), being single (OR=3.69, CI: 1.18-11.55), low economic status (OR=1.85, CI: 1.02-3.33) and attitude towards performance of health insurance (OR=0.86, CI: 0.75-0.99) were affected not having health insurance.
Approaches that cover the entire population may struggle to ensure no one is left without needed services. There is a need for greater focus on vulnerable groups to achieve universal health coverage conscientiously. Moreover, improved services and education can positively shape public perceptions of insurance efficacy, affecting their enrollment choices.
2014年5月，伊朗政府宣布将为所有未参保的伊朗人提供保险。尽管保险是免费的，但研究发现保险覆盖范围仍有待完善（93%）。本研究旨在了解为何尽管有免费保险，但某些人群仍未参保。这个问题并非伊朗独有；在许多其他国家也很普遍，尽管有免费保险，但并非所有人都利用它，从而使自己面临风险。
在一项匹配病例对照研究中，将89名未参保患者与178名有医疗保险的医院对照者（比例为2:1）进行比较。样本于2019年在该国一家主要公立医院（德黑兰伊玛目霍梅尼医院综合大楼）招募。为每个未参保人员选择两名参保对照者，并按照年龄（±5岁）和性别进行匹配。进行条件逻辑回归以评估影响程度，并使用拟合优度检验来检验模型。
失业（比值比（OR）=8.33，95%置信区间（CI）：1.05 - 50.0）、单身（OR = 3.69，CI：1.18 - 11.55）、经济地位低（OR = 1.85，CI：1.02 - 3.33）以及对医疗保险的态度（OR = 0.86，CI：0.75 - 0.99）会影响是否拥有医疗保险。
覆盖全体人口的方法可能难以确保无人得不到所需服务。需要更加关注弱势群体，以切实实现全民健康覆盖。此外，改善服务和教育可以积极塑造公众对保险效力的认知，影响他们的参保选择。
