جستجوی مقالات مرتبط با کلیدواژه « پرداخت از جیب » در نشریات گروه « پزشکی »

Financing in the health system will be fair when the costs related to health care for households are distributed according to their ability to pay and not according to the risk of disease. The aim of the present study was to investigate the inequality situation in households’ out-of-pocket payments for oral and dental health care in the Ahvaz, Iran households.

The present study is a cross-sectional study in which 715 households living in Ahvaz city in 2022-2023 were studied with stratified-cluster sampling. The required data was collected through a questionnaire to calculate the reliability, the questionnaire was implemented on a group of 10 households in a seven-day period, and their correlation coefficient was 0.89. Stata and Excel software were used to analyze the data.

According to this study, the proportion of oral and dental health expenses from the income of households in quintiles 1 to 5 is 69.41, 45.29, 27.77, 25.38 and 17.7 percent, respectively. Also, the Gini coefficient is equal to 0.384, the concentration index is equal to 0.174, and the Kakwani index is equal to -0.21. Also, the average percentage of out-of-pocket payments for dental services was 93.62%.

The out-of-pocket payments share of income for dental care was higher in the poorest quintile and it can be said that there is a downward trend in financing through out-of-pocket payments for oral and dental care. Therefore, health managers and policymakers should reduce the severity of the downward in financing by expanding insurance coverage and protecting the poor against unwanted oral and dental health expenses.

One of the criteria for measuring the performance of governments and their survival is the degree of success in reducing and stabilizing the misery index. The misery index is obtained from the sum of inflation and unemployment. Inflation and unemployment are the most important factors affecting family's income. If the misery index is high, families will have less money to buy their consumer goods, including the use of healthcare services and treatment. Therefore, this research has evaluated the relationship between misery index and patients' out-of-pocket payments in Iran's health system.

Using time series data of 1998-2019, this study has investigated the relationship between misery index and patients' out-of-pocket payments in Iran's health system. For this purpose, the Dickey-Fuller test was used to check the durability of the variables, the Todayamamoto causality test was used to check the causality relationship between the variables, and the autoregression method with distribution breaks was used to check the existence of a long-term relationship. In addition, the data and results were analyzed using Eview 9 software.

The results showed that there was a bi-directional causal relationship between the misery index and the out-of-pocket payments of patients in the health system. Furthermore, with increasing 1 unit of misery index 1.27 units of out-of-pocket payments increased. The correction error coefficient was 0.312, which meant this amount was adjusted each period by 0.312 from short-term imbalance to achieve long-term balance. In other words, it takes more than 3 years and less than 4 years to eliminate the short-term imbalances and reach its long-term relationship.

As the misery index increases, patients' out-of-pocket payments also increase. Therefore, the government should reduce the out-of-pocket payments of patients in the health system by adopting appropriate policies to reduce unemployment and inflation. Basic insurance coverage for essential services for patients should be increased. The extent of complementary medical insurance should be increased at the community level, especially in the lower deciles. In fact, the government should bear the cost of this part of the insurance for the four lower deciles. This is done in order to reduce the patients' out-of-pocket payments.

Nowadays, providing household health expenses is an important challenge in the health system and increasing the costs of health services have created problems in financing health expenses on families facing illness. In this regard, insurance seems to play a key role in such costs for households. Accordingly, the main purpose of this study is to investigate the factors affecting the devastating costs of health with emphasis on the role of insurance.

The present study is a descriptive-analytical and cross-sectional study that was conducted in medical hospitals of Tehran. 170 patients (households) were selected as the research sample and finally 165 patients (households) were included in the study. Data were collected using a questionnaire of the World Health Organization and finally analyzed using SPSS software.

In 2019, about 31% of our statistical population were exposed to staggering health costs. The results of the Logit econometric model show that households with more members under the age of 11 and over 65, whose head is unemployed, or who have a low level of education, or who are chronically ill, are more likely to incur staggering health costs. Meanwhile, the percentage of catastrophic health costs in households without insurance protection is very high.

Insurance protection along with economic indicators is one of the factors affecting the staggering costs of household health in Tehran.

Considering the growth of the elderly population and the need of the elderly for health services and the importance of supplementary insurance on improving the quality of life of the elderly households, this study aimed to investigate the effect of supplementary health insurance on out-of-pocket payments for elderly households in urban areas of Iran.

 This descriptive-analytical and applied study was conducted at the national level using the two-stage Hackman econometric method in Stata 16 software in 2021. The sample size was 6171 elderly households which data was extracted from different sections of the cost and income questionnaire of Iranian urban households in 2019.

Increasing age, education, and employment of the head of the household, increasing household size, having a private home, increasing per capita health expenditures and income of household had a positive effect on the probability of purchasing medical insurance.Increasing the age, level of education and employment of the head of the household led to an increase in out-of-pocket payments for the elderly household by 61164, 84466 and 140032 Rials per month, respectively. Having supplementary health insurance, living in provinces with high human development and being an elderly head of household increased the out-of-pocket payments to 606207, 849739 and 109274 Rials per month, respectively.

 Elderly households were less likely than other households to purchase supplementary health insurance and having supplementary health insurance by an elderly household led to an increase in out-of-pocket payments compared to other elderly households. Therefore, to reduce out-of-pocket payments, increase coverage Insurance of health goods and services required by the elderly as well as reduction of the elderly franchise is offered.

Measuring financial support is determined by the amount of out of pocket payment for receiving health services. The aim of this study was to compare the amount of patients out of pocket payment for medical expenses before and after its health reform plan.

This study is cross-sectional that was done in two time periods before and after the healthcare reform plan in Hazrat Fatima hospital affiliated to University of Medical Sciences, Iran. The data collection tool was a researcher-made checklist and data analysis was done using the spss program.

After implementation of the health reform plan in patients under study, there was an increase in the cost of treatment items for patients, including hoteling costs, labs and anesthesia. Also, after implementation of the health reform plan in patients under study, there was a decrease in the cost of treatment items for patients, including the cost of diagnostic imaging, medicine, rehabilitation, surgery and other expenses.

Based on the plan for the development of the health system of the country, all drugs, equipment and consumables of medical patients will be provided by the hospital. Hospitalized patients will not be guided to these items outside of the hospital, which can be attributed to the reduction of treatment costs in the plan of development Health system. In the event of sustained resources and commitment by the government to reduce the health costs of the population, the necessary ground should also be provided by the Ministry of Health and the country's insurance and health insurance funds in order to improve the quality of the desirable service delivery. And the level of satisfaction of all citizens, as well as the quality of services with quantitative indicators, should be constantly monitored and the conditions for increasing the efficiency and efficiency and commitment to the medical profession should be improved every day.

One of the important aspects of the health system reform plan is the protection of households and patients against medical expenses. They suffer from the financial burden of paying for medical expenses, as well as their illness. This study aimed to estimate the out-of-pocket payment of patients for medical expenses in Urmia in 2017.

In this descriptive-analytical study, to estimate out-of-pocket, data were collected in three stages from 400 households who were selected randomly from the four main health care centers in Urmia. Data were gathered through questionnaires and interviews with the head of the household, hospital records, insurance organizations, and medical tariffs, and were analyzed using SPSS software version 16.

According to the results, the average amount of out-of-pocket direct payment was calculated to be 53.07%. Basic insurance, supplementary insurance, and self-treatment were allocated 32.79%, 11.17% and 2.94% of total treatment costs, respectively.

The results of the study and comparisons with pre-implementation health reform plan studies showed that this plan is very successful in the inpatient area and the OOP rate is significantly lower than the designated target; but in the outpatient area, the plan is not successful, mainly due to the high costs in the dental services sector and the lack of support by insurance organizations.

Given the rising trend of ageing and the vulnerability of the aged group to diseases and health costs, it is important to determine the exposure of elderly households to the burdensome costs of health.

The incidence and severity of elderly costs at provincial level and income quintiles were calculated; besides, chi-square test was used to determine the relationship between household socioeconomic variables and exposure levels. The sample included 9103 elderly people aged 65 and over, and the data of their own and their households were extracted from the statistical center in 2016. Data analysis was performed using SPSS16 software.

The exposure rate of households with rural elderly people (9.74%) was higher than urban ones (6.2%), and the intensity of exposure was higher in rural areas than urban. In both groups, the highest exposure was in the second and the lowest in the fifth quintiles. The elderly households in Hormozgan province had the highest and in Kohgiluyeh and Boyer-Ahmad had the lowest exposure. Number of elderly people in family, place of residence, employment status, household dimension, costs of chemotherapy, addiction abandonment, orthopedics, special medications, household spending and out-of-pocket payment for health services were significantly correlated with exposure. However, elderly person's literacy, insurance, marital status and the presence of persons under 12 years in the family did not show a significant relationship with the amount of exposure.

The exposure rate and its intensity is higher among rural elderly people than urban ones, and the exposure of poorer elderly people is higher; these points indicate that the distribution of financial resources in the health system is not fair and requires  purposeful policymaking decisions for these groups.

Health insurance is one of the most important components of health care financing to reduce inequality in out-of-pocket payments. Therefore, considering the importance of insurance, increased out-of-pocket payment, and the demand for private insurance, and also the multiplicity of insurance funds, this study aimed to investigate the effects of health insurance on out-of-pocket payments among urban households in Iran.

In this applied, descriptive-analytic study, conducted in 2016, a sample of 17809 urban households in different provinces were recruited from the Center of Statistics of Iran. A household cost-income questionnaire, prepared and completed by the Center of Statistics of Iran, was used to collect data which were then analyzed by using the Stata 14 and double sample selection method.

The results showed that the household head's literacy and marital status, the family size, the number of children and elderly, wealth, per capita income and expenditures on education and tobacco had a direct effect on the probability of buying health insurance. Furthermore, households with one type of health insurance had to tolerate more out-of-pocket payments than the other households and finally, households with health insurance, social security insurance and other insurances experienced the highest out-of-pocket payments.

The significant difference between the out-of-pocket payments to different insurance types necessitates the establishment of an integrated insurance system which provides the same level of goods and services to all people in the community. On the other hand, the harmonization of health tariffs can reduce the inequality in out-of-pocket payments among the households. Moreover, it is recommended to have a system for monitoring the quality of care.

Aging population is one of the most important demographic phenomena associated with increasing costs and demand for health services. Hence, planning and utilizing health services is a very important concern for the elderly as well as the politicians. The purpose of this study was to determine the status of utilization of outpatient health services among the elderlies of Yazd in 2018. This cross-sectional study was conducted on 300 elderly people in Yazd. The participants were selected using stratified sampling method. Data were collected using a structured questionnaire with 37 questions, which included three sections of demographic information, household characteristics, and health care utilization status. To analyze the data, SPSS 20, chi-square test tests, and logistic regression at a significant level of 0.05 were applied. The frequently visited places by patients to receive the outpatient services were specialist physicians' offices (34.0 %) and the most common cause to receive the outpatient services was cardiovascular diseases (34.0 %). Women (59.9 %) more than men and housewives (61.4 %) more than other people benefited from outpatient services. The average cost paid for the outpatient services was 500,000 Rials and 53.2 % of the elderly spent less than this amount. Factors affecting utilization of outpatient services included marriage, complementary insurance, education, specific illness, and household size. Cardiovascular disease is the most common cause of utilizing the outpatient services, which leads to an increase in the demand for outpatient health services. The utilization of these services is also affected by factors such as marital status, complementary insurance, education, specific illness, and household size. Therefore, proper planning is essential in this regard.

The rate of out of pocket in health services has particular importance in health system. The aim of this study was to assess the rate of out of pocket and also the satisfaction with reimbursement process.

This study was across- sectional one which was done in 2018. At all 1177 war survivors and their families whom were covered by supplementary insurance were studied and they were selected randomly. In this study the questionnaire which was used in similar previous study, used for collecting data.

At all 1177 veterans, their families and martyrs' families were studied. About 53 percent (622 persons) of them had paid out of pocket for health services during the one year. In reimbursement process the satisfaction of 622 studied persons with the waiting time, providers, service place and repayment process was 33%, 69%, 54% and 39%.respectively. Also the waiting time and situation of cost repayment effected on satisfaction with reimbursement process.

Base on this study results decreasing the rate of out of Pocket Payment and increasing the satisfaction with reimbursement Process are important. For next study it is recommended appropriate project resulted in strategies for improving reimbursement Process.

This study aimed to investigate the relationship between hospital cost based on current procedural terminology and patients’ out-of-pocket payment by examining the most common surgical procedures in Oil Company retires, including cataract surgery, coronary angiography, total knee arthroplasty, and total hip replacement. This applied study utilized a descriptive - analytical design. The target population included oil company retires hospitalized in private hospitals in Tehran. The data were collected by examining the medical records archived in the Oil Industry Pension Fund from 2014 to 2015. In total, 920 samples were selected, 459 of which had been gathered before the implementation of Current Procedural Terminology and 461 after its implementation. In the end, the data were analyzed using SPSS V. 20 software by paired t-test and Wilcoxon test. The results of statistical tests showed a significant difference in the direct payment of patients undergoing angiography before and after the implementation of Current Procedural Terminology (P < 0.05). In addition, the Wilcoxon test showed a significant difference in the patient’s franchise for cataract surgery (P = 0.01; Z = -12.07). The health reform plan has increased the out-of-pocket payment in private hospitals. However, it can be reduced by proper monitoring and management.

  A significant portion of household’s expenses is allocated to health services. This study aimed to investigate the share of health expenditure in total households’ expenditure during 2009 - 2016 and capture the changing patterns of health expenditure associated to the implantation of the Health Transformation Plan. The study relied on data from the Household, Expenditure and Income survey, which the sample size is about 38000 households per year. The average annual out-of-pocket (OOP) expenses paid by households as well as the ratio of necessary expenditure in total consumption expenditure were calculated in order to study the trend of health expenditure. Out of pocket payment among all households has a slow decreasing trend. The ratio of health expenditure to total consumption expenditure in the 10th and 1st declines of urban and rural population was 26% and 1.3%, respectively; the national level was 7% in this period. The difference in OOP between the 1st and 10th decline in urban and rural households was 29942534 Rials and 15441113 Rials, respectively in 2016. The results indicate that there is a considerable difference between OOP paid by the poorest and the richest households. However, the share of health expenditure in total households’ expenditure was almost stable during these years. Despite, the increased coverage of universal health insurance in recent years, the difference between health expenditures among income groups is almost considerable. Nevertheless, health expenditure represents a lower share of total households’ expenditure compared with other expenditures among all expenditure deciles.

Most of the reforms that have taken place in world health systems are aimed at increasing the efficiency, quality, and control of costs. By implementing the health system reform plan, the actual plan of medical services tariffs by communicating the relative value of health services instruction on October 2014 was started. One of the most important goals of the reform plan was to reduce out of pocket payment. This study was conducted to determine the amount of out of pocket payment of insured people covered by the health insurance organization in the selected hospitals in Bushehr province.
The present analytical study was conducted on insured people hospitalization cases of health insurance organization in selected hospitals affiliated to Bushehr University of Medical Sciences (Persian Gulf Martyrs Hospital, Shahid Ganji Hospital) in July, August, January, and February 2014 as the statistical population and the most common services used as the statistical sample. The data were collected using a researcher-made checklist and investigating the hospital records coded and analyzed by SPSS 20 software.
According to the results of the study, the average cost of the patient's share was 1050835 Rials in July, August to 611631 Rials in January, and February, which decreased by 42.00 %. The results of the study show that by implementing the relative value of services instruction, the share of the health insurance organization increased from 79.00 % to 84.00 % and the share of the patient's payments decreased from 8.00 % to 4.00 %.
The results of the study show that the government has been able to achieve one of the goals of the health reform plan, which is reducing the out of pocket payment, by increasing health resources.

Pharmacies are considered as the necessary centers for public and patients. In Iran, a great deal of health sector resources is consumed for procurement of medicines. This survey is conducted to investigate pharmaceutical system of Shiraz pharmacies from the clients` view points.
This was a cross sectional survey that was conducted in 2016. The study population includes those who refer to community pharmacies, governmental and special pharmacies. The study sample was considered 150 according toCochranformula. A researcher made form was applied for data collection which its reliability was estimated 0.88 applying Pearson Correlation and the validity was approved through experts` views. SPSS22 was used for data analysis was applying Kruskal–Wallis one-way analysis of variance and Fisher`s exact test.
According to Kruskal–Wallis a significant relationship was considered between patient satisfaction and pharmacy type(p=0.046), pharmacy type and waiting time(p0.05).
It seems that considering the present results, the university superiors must try to decrease out of pocket payment on medicines through correct policy making. At the same time, accordance with general educations about drug use and social marketing for improving health literacy they should try to increase satisfaction toward the pharmacies.

One of the main goals of health sector evolution plan is reducing the amount of out of pocket payment by patients receiving hospital services in public sectors. This study aimed to assess the amount of out of pocket payment by inpatients in public hospitals affiliated to Shahid Beheshti University of Medical Science in Tehran city in 2015.
In this cross-sectional study, 405 discharged patients from four public and teaching hospitals were selected using convenient sampling method. Data were collected using a researcher made checklist and investigating the hospital bills. In order to data analysis, descriptive statistics and regression analysis were utilized through SPSS Software version16.
The amount of out of pocket payment was 10.2 percent included 9.9 percent formal payment, 0.2 percent bought & brought goods and 0.1 percent informal payment. The most portion of the hospital costs was related to medical supplies and pharmaceuticals, surgeries services and hosteling with 32.6, 20.6 and 17.36, respectively. Type of hospital, having surgery, average length of stay, family size and gender had significant effect on the out of pocket payment amount (p ≤ 0.05).
The amount of out of pocket payment by inpatient in public hospitals was in accordance with goal of the health sector evolution plan, which reveals the appropriate government support. It is recommended to tailor and implement enormous plans regarding outpatients and private sector in national level to attain sustained reduction in out of pocket payment.

The World Health Organization (WHO) has placed special emphasis on the protection of families against the costs of health services. Patients suffer not only from the burden of a disease, but also from the burden of their health costs. The aim of this study was to estimate out-of-pocket costs and to identify the factors that affect catastrophic expenditures among patients with cardiovascular diseases in Khuzestan Province.
In this descriptive-analytic study, 100 cardiovascular patients having referred to educational hospitals in Ahwaz, Khuzestan Province, were considered. Out-of-pocket costs were estimated and using Econometrics Logit model, factors affecting catastrophic expenditures among households were identified. All analyses were performed using SPSS and Stata.
The average out-of-pocket cost was 16,008,936 rials per patient during one year. Also, 55% of patients faced with catastrophic expenditures. Income level and family size had a significant negative impact; however, patients’ employment status had a positive but insignificant effect on catastrophic expenditures.
Hospital inpatient expenses and drug costs cover most of out-of-pocket expenditures and should be considered by policymakers. By increasing the income level and family size, families will encounter catastrophic expenditures less. The out-of-pocket costs among patients with cardiovascular diseases can be reduced by boosting the insurance coverage and government help.

Dental care is globally expensive with the greatest portion of the costs imposed on patients. This study was conducted to investigate utilization rate of dental services and out-of-pocket payments (OOP) in dental clinics of Ramsar, Iran, 2015.
In this cross-sectional study, 302 patients referred to Ramsar dental clinics were selected through stratified sampling. The data was collected through review of patient records and telephone interviews with patients. Data was analyzed using descriptive statistics and regression test in SPSS, version 21.
The highest utilization rate with 66.9% was related to reconstructive services and the lowest pertained to orthodontic services. Root canal therapy, orthodontics and prosthesis had the highest share of OOP and the highest insurance coverage with 30% related to surgical services. Overall, the share of OOP in dental care costs was 91%. Employment status, educational level, annual household income, and having elderlies (aged over 65 years old) in the household had significant impact on OOP payments (P≤0.05).
Due to the high OOP payment, new policies on insurance coverage of dental services should be adopted. We recommend national policies to be focused on preventing dentistry services, as well as designing and establishing public dental clinics in public hospitals and prioritizing low-income groups.

One of the fair financial protection indexes in monitoring health systems is estimating impoverishment due to health care expenditure. The aim of this study was to measure the percentage of households impoverished due to out-of-pocket(OOP) payments in Iran provinces during2008-2014.
The present retrospective descriptive study was conducted based on data from Household Income and Expenditure Survey in both rural and urban households. The proportion of households that moved below the poverty line after deducting health care costs was calculated. The poverty line for urban and rural areas was calculated based on household food expenditure. To show the provincial dispersion of the index during this period, the coefficient of variation(CV) was used. Mann-WhitneyU test and descriptive statistics were used to analyze the data.
Golestan, North Khorasan, and Kerman had the highest impoverishment rate due to OOP Moreover, Alborz, Tehran, and Bushehr had the lowest impoverishment rate due to OOP. In all the study years, the average impoverishment due to OOP was significantly higher in rural areas compared to urban areas. Provincial dispersion CV for this index did not have a constant trend.
The results of this study provide valuable evidence for policy-makers to estimate the impact of OOPs on household impoverishment. In order to reduce impoverishment due to OOP, supportive targeted interventions for vulnerable and low-income households, especially rural households, in addition to decreasing the share of OOP, are essential, such as developing health subsidies and improving insurance service packages.

Measurement of financial support for health services is determined by household out of pocket expenditure for health which is associated with two approaches: catastrophic and impoverishing health expenditures. Therefore, this study aimed to investigate the catastrophic and impoverishing health expenditure in Tehran urban population.
This cross-sectional study was conducted in Tehran in 2013. The data were collected through interview and observation using a household expenditure questionnaire. In order to estimate the effects of factors affecting catastrophic health expenditure and impoverishing health expenditure, data analysis was done using Pearson test, one variable and multivariate logistic models, Excel and STATA Software.
According to the finding 2.4% of households fell below the poverty line, 6.7% of families households had to pay out of pocket, and 3.8% were identified as facing catastrophic health expenditures as a result of out-of-pocket payment for health.
There are some key factors influencing health expenditure, such as head of household education level, the presence of people over 60 years in household, the use of inpatient services and the volume of use. Therefore, it is recommended that health policy makers and insurance organizations implement health insurance plans and reduce the health services tariff and out of pocket expenditure on health.