ﺑﺮرﺳﯽ آﺳﺘﺎﻧﻪ ﻣﻨﺎﺳﺐ ﺑﺮاي ﺳﻨﺠﺶ رﺧﺪاد و ﺷﺪت ﻣﻮاﺟﻬﻪ ﺧﺎﻧﻮارﻫﺎ ﺑﺎ ﻣﺨﺎرج ﮐﻤﺮﺷﮑﻦ ﺳﻼﻣﺖ در اﯾﺮان

Investigating Appropriate Threshold for Measuring the Occurrence and Intensity of Households' Exposure to Catastrophic Health Expenditure in Iran

ﻣﻘﺪﻣﻪ و اﻫﺪاف: ﺣﻔﺎﻇﺖ ﻣﺎﻟﯽ ﻋﺎدﻻﻧﻪ در ﻣﻘﺎﺑﻞ ﻫﺰﯾﻨﻪﻫﺎي ﺳﻼﻣﺖ از ﻣﻬﻢﺗﺮﯾﻦ اﻫﺪاف ﻧﻈﺎمﻫﺎي ﺳﻼﻣﺖ ﻣﺤﺴﻮب ﻣﯽﺷﻮد. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ ﻣﻨﺎﺳﺐﺗﺮﯾﻦ آﺳﺘﺎﻧﻪ ﺑﺮاي ﺳﻨﺠﺶ رﺧﺪاد ﻣﻮاﺟﻬﻪ ﺧﺎﻧﻮارﻫﺎ ﺑﺎ ﻣﺨﺎرج ﮐﻤﺮﺷﮑﻦ ﺳﻼﻣﺖ در اﯾﺮان اﻧﺠﺎمﺷﺪه اﺳﺖ. روش ﮐﺎر: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ اﺳﺘﻔﺎده از دادهﻫﺎي ﭘﯿﻤﺎﯾﺶ ﻣﻠﯽ ﻫﺰﯾﻨﻪ-درآﻣﺪ ﺧﺎﻧﻮار ﻣﺮﮐﺰ آﻣﺎر اﯾﺮان ﺳﺎل 1396 اﻧﺠﺎم ﺷﺪ. ﺑﺎ اﺳـﺘﻔﺎده از دو روش ﺳﺎزﻣﺎن ﺟﻬﺎﻧﯽ ﺑﻬﺪاﺷﺖ و ﺑﺎﻧﮏ ﺟﻬﺎﻧﯽ رﺧﺪاد و ﺷﺪت ﻣﻮاﺟﻬﻪ ﺧﺎﻧﻮارﻫﺎ ﺑﺎ ﻣﺨﺎرج ﮐﻤﺮﺷﮑﻦ ﺳﻼﻣﺖ در ﻧﻘﺎط ﺑـﺮش ﻣﺨﺘﻠـﻒ و ﺑـﺮاي ﭘﻨﺠﮏﻫﺎي اﻗﺘﺼﺎدي اﻧﺪازهﮔﯿﺮي ﺷﺪ. ﻣﻨﺎﺳﺐﺗﺮﯾﻦ آﺳﺘﺎﻧﻪ در ﻫﺮ ﯾﮏ از روشﻫﺎ ﻧﯿﺰ ﺑﺎ اﺳﺘﻔﺎده از ﺑﺮآورد ﺳﺎزﮔﺎري آﻣﺎره ﮐﺎﭘﺎ ﺗﻌﯿﯿﻦ ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: رﺧﺪاد ﻣﻮاﺟﻬﻪ ﺧﺎﻧﻮارﻫﺎ ﺑﺎ ﻣﺨﺎرج ﮐﻤﺮﺷﮑﻦ در آﺳﺘﺎﻧﻪ ﻣﺮﺳﻮم ﻫﺮ دو روش ﺑﻪ ﺗﺮﺗﯿﺐ 3/02 و 8/51 درﺻﺪ در ﺧﺎﻧﻮارﻫﺎي ﺷﻬﺮي و 4/66 و 9/22 درﺻﺪ در ﺧﺎﻧﻮارﻫﺎي روﺳﺘﺎﯾﯽ ﺑﺮآورد ﮔﺮدﯾﺪ. اﯾﻦ ﻣﻘﺪار ﺑﻪ ﺗﻔﮑﯿﮏ ﭘﻨﺠﮏﻫﺎي داراﯾﯽ ﻧﺸﺎندﻫﻨﺪه ﺑﯿﺸﺘﺮﯾﻦ رﺧـﺪاد ﻣﺨـﺎرج ﮐﻤﺮﺷﮑﻦ در ﭘﻨﺠﮏ اول و ﮐﻤﺘﺮﯾﻦ رﺧﺪاد در ﭘﻨﺠﮏ ﭘﻨﺠﻢ ﺑﻮد. ﻫﻤﭽﻨﯿﻦ ﻧﺘﺎﯾﺞ ﺑﺮآورد ﺳﺎزﮔﺎري ﺑﺮ اﺳﺎس آﻣﺎره ﮐﺎﭘـﺎ ﺑـﻪﻣﻨﻈﻮر ﺷﻨﺎﺳـﺎﯾﯽ ﺑﻬﺘﺮﯾﻦ ﺣﺪ آﺳﺘﺎﻧﻪ ﻣﺤﺎﺳﺒﻪ ﻣﻮاﺟﻬﻪ ﯾﺎﻓﺘﮕﯽ ﺑﺎ ﻣﺨﺎرج ﮐﻤﺮﺷﮑﻦ ﺳﻼﻣﺖ ﻧﺸﺎن داد ﮐﻪ آﺳﺘﺎﻧﻪ 40 درﺻﺪ روش ﺳـﺎزﻣﺎن ﺟﻬـﺎﻧﯽ ﺑﻬﺪاﺷـﺖ و آﺳﺘﺎﻧﻪ 25 درﺻﺪ در روش ﺑﺎﻧﮏ ﺟﻬﺎﻧﯽ ﻣﻨﺎﺳﺐﺗﺮﯾﻦ ﺣﺪود آﺳﺘﺎﻧﻪ ﻣﯽﺑﺎﺷﻨﺪ. ﻧﺘﯿﺠﻪﮔﯿﺮي: ﻧﺘﺎﯾﺞ ﻣﻄﺎﻟﻌﻪ ﺣﺎﮐﯽ از ﻣﻘﺪار ﻧﺴﺒﺘﺎً ﺑﺎﻻي ﻣﻮاﺟﻬﻪ ﺑﺎ ﻣﺨﺎرج ﮐﻤﺮﺷﮑﻦ ﺳـﻼﻣﺖ ﺑـﻮد. ﻫﻤﭽﻨـﯿﻦ رﺧـﺪاد ﻣﻮاﺟﻬـﻪ ﺑـﺎ ﻣﺨـﺎرج ﮐﻤﺮﺷﮑﻦ ﺳﻼﻣﺖ در ﺧﺎﻧﻮارﻫﺎي ﻓﻘﯿﺮﺗﺮ ﺑﯿﺸﺘﺮ ﺑﻮد و آﺳﺘﺎﻧﻪﻫﺎي ﻣﺮﺳﻮم ﻣﻨﺎﺳﺐﺗﺮﯾﻦ آﺳﺘﺎﻧﻪ ﺑﺮاي ﺑﺮآورد ﻣﺨﺎرج ﮐﻤﺮﺷﮑﻦ ﺑﻮدﻧﺪ.

Fair financial protection against health expenditures is one of the most critical goals of health systems. This study was conducted to investigate the most appropriate threshold for measuring the exposure to catastrophic health expenditure (CHE) in Iran. Methods: The present study was conducted using 2018 national household income and expenditure data of the Iran statistics center. The occurrence and intensity of the households' exposure to CHE at different thresholds and for economic quintiles was measured using two World Health Organization (WHO) and World Bank (WB) methodologies. The most appropriate threshold for each methodology was also determined using the Kappa statistics adaptation estimation. Results: The occurrence of households’ exposure to CHE was 3.02% and 8.51% in urban households and 4.66% and 9.22% in rural households, respectively. According to asset quintiles, the highest occurrence was in the first quintile and the lowest in the fifth quintile. In addition, the results of adaptation estimation based on Kappa statistics showed that a threshold of 40% in the WHO methodology and 25% in the WB methodology were the most appropriate thresholds. Conclusion: The results showed a relatively high rate of exposure to CHE. CHE occurrence was also more in poorer households, and common thresholds were the most appropriate thresholds for estimating CHE.