Sheikhy-Chaman Mohammadreza, Rezapour Aziz, Aryankhesal Aidin, Aboutorabi Ali
Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2024 May 1;38:49. doi: 10.47176/mjiri.38.49. eCollection 2024.
Monitoring households' exposure to catastrophic health expenditure (CHE) based on out-of-pocket (OOP) health payments is a critical tool for evaluating the equitable financial protection status within the health system. The COVID-19 pandemic has brought unprecedented global change and potentially affected the mentioned protection indicators. This study aimed to assess the prevalence of CHE among households in Iran during the COVID-19 period.
The present study employed a retrospective-descriptive design utilizing data derived from two consecutive cross-sectional Annual Household Income and Expenditure Surveys (HIES) undertaken by the Statistical Centre of Iran (SCI) in 2020 and 2021. The average annual OOP health payments and the prevalence of households facing CHE were estimated separately for rural and urban areas, as well as at the national level. Based on the standard method recommended by the World Health Organization (WHO), CHE was identified as situations in which OOP health payments surpass 40% of a household's capacity to pay (CTP). The intensity of CHE was also calculated using the overshoot measure. All statistical analyses were carried out using Excel-2016 and Stata-14 software.
The average OOP health payments increased in 2021, compared to 2020, across rural and urban areas as well as at the national level. Urban residents consistently experienced higher OOP health payments than rural residents and the national level in both years. At the national level, the prevalence of CHE was 2.92% in 2020 and increased to 3.18% in 2021. In addition, rural residents faced a higher prevalence of CHE based on total health services OOP, outpatient services OOP, and inpatient services OOP compared to urban residents and the national level. Regarding the intensity of CHE using overshoot, the results for 2020 and 2021 revealed that the overshoot ranged between 0.60% and 0.65% in rural areas, between 0.30% and 0.33% in urban areas, and between 0.38% and 0.41% at the national level.
A considerable percentage of households in Iran still incur CHE. This trend has increased in the second year of COVID-19 compared to the first year, as households received more healthcare services. The situation is even more severe for rural residents. There is an urgent need for targeted interventions in the health system, such as strengthening prepayment mechanisms, to reduce OOP and ensure equitable protection for healthcare recipients.
基于自付医疗费用监测家庭灾难性卫生支出（CHE）情况，是评估卫生系统内公平财务保护状况的关键工具。新冠疫情带来了前所未有的全球变化，并可能影响上述保护指标。本研究旨在评估新冠疫情期间伊朗家庭中CHE的流行情况。
本研究采用回顾性描述性设计，利用伊朗统计中心（SCI）在2020年和2021年进行的两次连续横断面年度家庭收入和支出调查（HIES）数据。分别估算了农村和城市地区以及国家层面的年均自付医疗费用和面临CHE的家庭患病率。根据世界卫生组织（WHO）推荐的标准方法，将CHE定义为自付医疗费用超过家庭支付能力（CTP）40%的情况。还使用超支措施计算了CHE的强度。所有统计分析均使用Excel - 2016和Stata - 14软件进行。
与2020年相比，2021年农村和城市地区以及国家层面的年均自付医疗费用均有所增加。在这两年中，城市居民的自付医疗费用一直高于农村居民和国家层面。在国家层面，2020年CHE患病率为2.92%，2021年增至3.18%。此外，与城市居民和国家层面相比，农村居民基于总医疗服务自付费用、门诊服务自付费用和住院服务自付费用的CHE患病率更高。关于使用超支计算的CHE强度，2020年和2021年的结果显示，农村地区超支范围在0.60%至0.65%之间，城市地区在0.30%至0.33%之间，国家层面在0.38%至0.41%之间。
伊朗相当一部分家庭仍面临CHE。与第一年相比，在新冠疫情的第二年，随着家庭获得更多医疗服务，这一趋势有所增加。农村居民的情况更为严峻。卫生系统迫切需要有针对性的干预措施，如加强预付机制，以减少自付费用并确保为医疗服务接受者提供公平保护。
