College of Health Sciences, Catholic University in Erbil, Erbil, Iraq.
Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
J Health Popul Nutr. 2024 Aug 19;43(1):127. doi: 10.1186/s41043-024-00616-1.
Understanding healthcare-seeking behavior and examining health expenditures can help determine possible barriers to accessing healthcare and direct more effective and inclusive healthcare systems. This study aimed to evaluate healthcare-seeking behavior and out-of-pocket healthcare expenditure in a sample of the population in Erbil, Iraq.
We conducted this cross-sectional study in Erbil, Kurdistan Region of Iraq, from October to December 2023. A convenience sample of 414 adults completed a self-administered online survey. The following data were collected: recent illness, sociodemographic characteristics, type of healthcare received, and cost of healthcare.
The most common health conditions reported were communicable diseases (16.3%), musculoskeletal problems (13.1%), and noncommunicable diseases (12.7%). Approximately 85% of patients with health conditions requiring care sought healthcare; most visited private clinics (46.3%) and private hospitals (18.6%). The median total out-of-pocket healthcare expenditure in US dollars was 117.3 (interquartile range (IQR) = 45.6-410.0). The median total cost was much greater for participants who first visited a private health facility (USD 135.5, IQR = 57.3-405.6) than those who first visited a public facility (USD 76.8, IQR = 16.1-459.7). Participants ≥ 60 years spent significantly more than those < 14 years (USD 332, 95% CI = 211-453, p < 0.001). Evermarried participants spent significantly more than unmarried (USD 97, 95% CI = 1 to 192, p = 0.047). Health expenditures were significantly greater for noncommunicable diseases than infectious diseases (USD 232, 95% CI = 96-368, p = 0.001). After adjusting for covariates, age ≥ 60 years was independently associated with higher spending (USD 305, 95% CI = 153-457, p < 0.001).
Most participants sought care from formal health services, preferring the private sector. Seeking care from private facilities incurred significantly higher costs than seeking care from public ones, which suggests potential barriers to accessing healthcare, particularly affordability. The findings underscore the importance of evaluating existing healthcare policies to enhance effectiveness and identify areas for improvement. This study can help policymakers and healthcare providers design effective interventions, allocate resources efficiently, and improve healthcare delivery.
了解医疗保健寻求行为并检查医疗支出有助于确定获得医疗保健的可能障碍，并指导更有效和更具包容性的医疗保健系统。本研究旨在评估伊拉克库尔德斯坦地区埃尔比勒的一个人群样本中的医疗保健寻求行为和自付医疗支出。
我们于 2023 年 10 月至 12 月在伊拉克埃尔比勒进行了这项横断面研究。414 名成年人完成了一份在线自我管理的问卷调查。收集了以下数据：近期疾病、社会人口统计学特征、所接受的医疗保健类型和医疗保健费用。
报告的最常见健康状况是传染病（16.3%）、肌肉骨骼问题（13.1%）和非传染性疾病（12.7%）。约 85%有需要治疗的健康状况的患者寻求医疗保健；大多数人去了私立诊所（46.3%）和私立医院（18.6%）。以美元计算的总自付医疗保健支出中位数为 117.3（四分位距（IQR）= 45.6-410.0）。首次就诊于私立医疗机构的参与者的总费用中位数（USD 135.5，IQR= 57.3-405.6）远高于首次就诊于公立医疗机构的参与者（USD 76.8，IQR= 16.1-459.7）。≥60 岁的参与者比<14 岁的参与者花费显著更多（USD 332，95%CI= 211-453，p<0.001）。已婚参与者比未婚参与者花费显著更多（USD 97，95%CI= 1 至 192，p=0.047）。非传染性疾病的医疗支出显著高于传染病（USD 232，95%CI= 96-368，p=0.001）。调整协变量后，≥60 岁的年龄与更高的支出独立相关（USD 305，95%CI= 153-457，p<0.001）。
大多数参与者寻求正规卫生服务的医疗保健，更喜欢私营部门。从私立机构寻求医疗保健的费用明显高于从公立机构寻求医疗保健的费用，这表明获得医疗保健可能存在障碍，尤其是在负担能力方面。研究结果强调了评估现有医疗保健政策以提高效率和确定改进领域的重要性。本研究可以帮助政策制定者和医疗保健提供者设计有效的干预措施，有效地分配资源，并改善医疗保健的提供。
