The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications
The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications
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DOI：
10.1002/hpm.2900
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发表时间：
2019-08-27
影响因子：
2.7
通讯作者：
Abdi, Zhaleh
中科院分区：
文献类型：
--
作者：
Ahmadnezhad, Elham;Murphy, Adrianna;Abdi, Zhaleh
目的2014年，伊朗伊斯兰共和国启动了健康转型计划(HTP)，目标是通过改善经济保护和伊朗家庭获得高质量医疗服务的机会，实现全民健康覆盖(UHC)。我们的目的是调查HTP对自付医疗费用(OOP)的水平和模式的影响。方法使用伊朗统计中心在HTP实施前后收集的两轮家庭支出和收入调查(HEIS)的数据，我们估计OOP支付水平和驱动因素的变化，以及灾难性医疗支出(CHS)在伊朗家庭中的流行、强度和分布。研究结果表明，人均OOP医疗费用在观察期内保持稳定，其中药品OOP费用的比例最大。使用总消费量的10%和25%的阈值，CHE的患病率略有增加。CHE的患病率从3.76%上升到3.82%，达到总消费量的25%。使用40%的支付能力阈值，患病率从2.5%下降到2.37%，强度从13.16%下降到12.32%。在所有门槛上，CHE都更集中在较富裕的家庭中。结论这些结果表明，虽然伊朗贫困人口的经济保护因HTP而有所改善，但要在伊朗实现UHC，还需要做更多的工作。在下一阶段的卫生改革中，应更加重视将卫生筹资的OOP共同支付转变为累进的预付机制，以促进更好地在人口群体之间分担金融风险。
Purpose In 2014, the Islamic Republic of Iran launched the Health Transformation Plan (HTP), with the goal of achieving universal health coverage (UHC) through improved financial protection and access to high-quality health services among Iranian households. We aimed to investigate the impact of the HTP on the level and pattern of out-of-pocket (OOP) payments for health care. Methods Using data from two rounds (2013 and 2016) of the Iranian Statistics Centre's Household Expenditure and Income Survey (HEIS), collected before and after implementation of the HTP, we estimate changes in the level and drivers of OOP payments, and the prevalence, intensity, and distribution of catastrophic health expenditures (CHEs) among Iranian households. Findings Our results indicate that per capita OOP payments on health remained stable during the observed period, with the largest proportion of OOP payments spent on medicines. Using thresholds of 10% and 25% of total consumption, there was a slight increase in the prevalence of CHE. The prevalence of CHE increased from 3.76% to 3.82% at threshold of 25% of total consumption. Using 40% capacity to pay threshold, prevalence diminished modestly from 2.5% to 2.37% and the intensity decreased from 13.16% to 12.32%. At all thresholds, CHE were more concentrated among wealthier households. Conclusion These results suggest that while financial protection of the poor in Iran has improved due to the HTP, more work is needed to achieve UHC in Iran. For the next phase of health reforms, more emphasis should be placed on shifting away from OOP co-payments for health financing to progressive prepayment mechanisms to facilitate better sharing of financial risks across population groups.