Equity in Out-of-Pocket Payments for Healthcare Service Delivery in Urban and Rural Households: Evidence from Iran

Background: Out-of-pocket payments for medical services may undermine access to medical services and equity in healthcare financing. Objectives: The present study aimed to determine the distribution of the burden of out-of-pocket payments for healthcare services among the households in Qazvin province, Iran. Methods: This descriptive-analytical study was conducted on the urban and rural households in Qazvin province, Iran during ۲۰۱۹ - ۲۰۲۰. Data were obtained from the Statistics Center of Iran (۲۰۱۹ - ۲۰۲۰). The optimal sample size was calculated to be ۹۹۲ households, and the households were selected via three-stage random cluster sampling. Data were collected using a valid questionnaire and via face-to-face interviews with the household owners. The fair financial contribution index (FFCI), concentration index, and Kakwani index were estimated in the Stata software. Results: The estimated parameters indicated that during the study period (March ۲۱, ۲۰۱۹-March ۲۰, ۲۰۲۰), the FFCI value of the rural and urban households was ۰.۷۸۲ and ۰.۸۵۴, respectively. The out-of-pocket payment concentration index based on income rank was estimated at ۰.۱۸۸ in rural households (P < ۰.۰۵) and ۰.۰۳۱ in the urban households. In addition, the Kakwani index of the urban and rural households was calculated to be -۰.۱۶۵ and -۰.۸۴, respectively. Conclusions: According to the results, out-of-pocket payments were unequally distributed among the households in Qazvin province in ۲۰۱۹ - ۲۰۲۰. These payments were mostly concentrated on the ۵th - ۷th deciles of urban households. On the other hand, the out-of-pocket payments during the study period were regressive. To promote financial equity, Qazvin health policymakers must run payment exemptions for low-income groups and also expand the medical insurance coverage and universal coverage of healthcare services.

کلیدواژه ها:

Equity in Financing ، Out-of-Pocket ، Health Expenses ، Concentration Index ، Kakwani Index ، Fair Financial Contribution Index