Inequality in household catastrophic health care expenditure in a low-income society of Iran
Inequality in household catastrophic health care expenditure in a low-income society of Iran
复制标题
DOI：
10.1093/heapol/czs001
复制
发表时间：
2012-10-01
影响因子：
3.2
通讯作者：
Arab, Mohammad
中科院分区：
文献类型：
--
作者：
Kavosi, Zahra;Rashidian, Arash;Arab, Mohammad
方法2003年采用《世界卫生调查问卷》进行整群抽样调查。我们在2008年对同一样本进行了重复调查（分别为635户和603户）。我们使用“家庭支付能力”来估计面临CHE的家庭比例。我们使用回归分析确定了家庭CHE的决定因素，并使用浓度指数来衡量社会经济不平等并将其分解为决定因素。结果发现，在此期间，面临CHE的家庭比例没有显著变化（2003年为12.6%，2008年为11.8%）。在这两年中，卫生保健利用情况和卫生保健保险状况是决定卫生保健水平的关键因素。社会经济地位是造成医疗保健不平等的主要因素，而牙科和门诊服务的不平等利用减少了社会经济群体之间医疗保健的不平等。结论：尽管政策干预旨在减少此类支出，但我们观察到CHE比例没有显著变化。任何解决CHE问题的办法都应包括针对CHE决定因素的干预措施。必须通过扩大基本福利计划和减少共同支付来增加社会保险覆盖的深度。
Methods A cluster-sampled survey was conducted in 2003 using the World Health Survey questionnaire. We repeated the survey on the same sample in 2008 (635 and 603 households, respectively). We estimated the proportion of households facing CHE using the 'household's capacity to pay'. We identified the determinants of the household CHE using regression analysis and used the concentration index to measure socio-economic inequality and decompose it into its determinants factors.Results Findings showed that the proportion of household facing CHE had no significant change in this period (12.6% in 2003 vs 11.8% in 2008). The key determinants of CHE for both years were health care utilization and health care insurance status. Socio-economic status was the main contributor to inequality in CHE, while unequal utilization of dentistry and outpatient services had reduced the inequality in CHE between socio-economic groups.Conclusions We observed no significant change in the CHE proportion despite policy interventions aimed at reducing such expenditures. Any solution to the problem of CHE should include interventions aimed at the determinants of CHE. It is essential to increase the depth of social insurance coverage by expanding the basic benefit package and reducing co-payments.