fa تأثیر ابعاد نابرابری بر تأمین مالی هزینه های بهداشت خانوار؛ مطالعه موردی شهرستان تهران تخصصي Special پژوهشي Research <span style="font-size:11pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="FA" style="font-size:12.0pt"><span 2="" style="font-family:" titr=""><span style="color:black">مقدمه</span></span></span></b><b><span dir="LTR" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"><span style="color:black">:</span></span></span></b> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">نبود</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">محافظت</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">مالی</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">در</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">سلامت</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">به</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">عنوان</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">بیماری</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">نظام</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">های</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">سلامت</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">شناخته</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">شده</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">است.</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">خانوارها</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">نه</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">تنها</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">از</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">بار</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">بیماری،</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">بلکه</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">از</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">بار</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">ناشی</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">از</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">نابودی</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">و</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">فقر</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">اقتصادی</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">و</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">به</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">عبارتی</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">دیگر</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">مواجهه</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">با</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">هزینه</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">های</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">کمرشکن</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">و</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">فقر ناشی</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">از</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">تأمین</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">مالی</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">سلامت</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">خود</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">رنج</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">می</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">برند</span></span><span dir="LTR" new="" roman="" style="font-family:" times=""><span style="color:black">.</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"> هدف از پژوهش حاضر بررسی تاثیر ابعاد مختلف نابرابری بر تامین مالی هزینه ای بهداشت خانوار می باشد.</span></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="text-autospace:none"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="FA" style="font-size:12.0pt"><span 2="" style="font-family:" titr=""><span style="color:black">روش</span></span></span></b><b> </b><b><span lang="FA" style="font-size:12.0pt"><span 2="" style="font-family:" titr=""><span style="color:black">پژوهش</span></span></span></b><b><span dir="LTR" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"><span style="color:black"> :</span></span></span></b> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">این</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">مطالعه</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"> توصیفی،</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">مقطعی وکاربردی می باشد</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">،</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">که به بررسی تاثیر نابرابری بر تامین مالی هزینه های بهداشت خانوار می پردازد.</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">ابزار</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">پژوهش</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">پرسشنامه</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">نابرابری تامین مالی </span></span><span dir="LTR" new="" roman="" style="font-family:" times=""><span style="color:black">(2008) saito</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">&nbsp;می باشد.</span></span><span class="MsoPlaceholderText" style="color:gray"><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"> تمام هزینه های پرداخت از جیب مربوط به مراقبت های بستری، سرپایی، آزمون های تشخیصی و هزینه های دارویی ناشی از بیماری برای یک سال برآورد گردیده است.</span></span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"> روایی و پایایی توسط خبرگان تایید شده است.</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"></span></span></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="FA" style="font-size:12.0pt"><span 2="" style="font-family:" titr=""><span style="color:black">یافته ها :</span></span></span></b><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"> ابعاد نابرابری در بین خانوار تهران با توجه به میانگین جامعه (1.329) بیشتر از حد متوسط می&shy;باشد</span></span><span b="" lang="AR-SA" nazanin="" style="font-family:"><span style="color:black"> که بر تامین مالی هزینه های بهداشت خانوار تاثیر معنی داری دارد.</span></span> <span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">اثر مستقیم عدالت برتامین مالی هزینه بهداشت خانوار رد می‌گردد. با افزایش هزینه کمرشکن، فرصت یکسان، وضعیت اقتصادی، نوع پوشش بیمه، تامین مالی هزینه بهداشت خانوار، افزایش می&shy;یابد.</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"> باتوجه به</span></span> <span dir="LTR" new="" roman="" style="font-family:" times=""><span style="color:black">P<0/001</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">و </span></span>&nbsp;<span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">005/0 </span></span><span dir="LTR" new="" roman="" style="font-family:" times=""><span style="color:black">P</span></span><span dir="LTR" style="color:black">=</span><span b="" nazanin="" style="font-family:"><span style="color:black"> سن سرپرست خانوار با عدالت و جنسیت با تامین مالی هزینه های بهداشت خانوار ارتباط ندارد.</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"></span></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="FA" style="font-size:12.0pt"><span 2="" style="font-family:" titr=""><span style="color:black">نتیجه</span></span></span></b><b> </b><b><span lang="FA" style="font-size:12.0pt"><span 2="" style="font-family:" titr=""><span style="color:black">گیری</span></span></span></b><b><span dir="LTR" style="font-size:12.0pt"><span b="" nazanin="" style="font-family:"><span style="color:black">:</span></span></span></b><span b="" nazanin="" style="font-family:"><span style="color:black"> بین هزینه های کمرشکن، فرصت یکسان، وضعیت اقتصادی، نوع پوشش بیمه و تامین مالی هزینه های بهداشت خانوار </span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">رابطه مستقیم وجود دارد</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black">.</span></span><span b="" lang="FA" nazanin="" style="font-family:"><span style="color:black"></span></span></span></span></span></span></span><br> &nbsp; <span style="font-size:11pt"><span style="background:#f8f9fa"><span style="line-height:27.0pt"><span style="tab-stops:45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124">Abstract</span></span></b></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="background:#f8f9fa"><span style="line-height:27.0pt"><span style="tab-stops:45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124">Introduction:</span></span></b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124"> Lack of financial protection in health is known as a disease of health systems. Households suffer not only from the burden of disease but also from the burden caused by the destruction and economic poverty, in other words, facing back-breaking costs and poverty caused by financing their health. The aim of the current research is to investigate the impact of different dimensions of inequality on the financial financing of household health</span></span><span new="" roman="" style="font-family:" times=""><span style="color:#202124">.</span></span></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="background:#f8f9fa"><span style="line-height:27.0pt"><span style="tab-stops:45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124">&nbsp;method:</span></span></b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124"> This is a descriptive, cross-sectional, and applied study, which examines the impact of inequality on the financing of household health expenses. The research tool is the financing inequality questionnaire (2008) by Saito. All out-of-pocket costs related to inpatient care, outpatient care, diagnostic tests, and medical expenses due to illness have been estimated for one year. Experts have confirmed validity and reliability.</span></span></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="background:#f8f9fa"><span style="line-height:27.0pt"><span style="tab-stops:45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124">Findings:</span></span></b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124"> The dimensions of inequality among households in Tehran are higher than the average (1.329), which has a significant impact on the financing of household health expenses. The direct effect of justice on the financing of household health expenses is rejected. With the increase in the back-breaking cost, equal opportunity, economic status, insurance coverage, and financing of household health expenses increases. According to P<0.001 and P=0.005, the age of the head of the household is not related to justice and gender in the financing of household health expenses.</span></span></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="background:#f8f9fa"><span style="line-height:27.0pt"><span style="tab-stops:45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="unicode-bidi:embed"><span style="font-family:Calibri,sans-serif"><b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124">Conclusion:</span></span></b><span lang="EN" new="" roman="" style="font-family:" times=""><span style="color:#202124"> There is a direct relationship between back-breaking expenses, equal opportunity, economic status, insurance coverage, and financing of household health expenses.</span></span></span></span></span></span></span></span><br> &nbsp; ابعاد نابرابری, تامین مالی, هزینه های بهداشت خانوار, سرپرست خانوار, تهران dimensions of inequality, financing, household health costs, household head, Tehran 286 291 http://journal.ihio.gov.ir/browse.php?a_code=A-10-361-1&slc_lang=fa&sid=1 Shaghayegh Vahdat شقایق وحدت sha_vahdat@gmail.com 10031947532846004105 10031947532846004105 No Department of Health Services Management, South Tehran Branch, Islamic Azad University, Tehran, Iran گروه مدیریت خدمات بهداشتی درمانی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران Asieh Khaleghi آسیه خالقی a.kgaleghi2014@gmail.com 10031947532846004106 10031947532846004106 No Department of Health Services Management, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran گروه مدیریت خدمات بهداشتی و درمانی، واحد مرودشت، دانشگاه آزاد اسلامی، مرودشت، ایران Arsalan Gholami ارسلان غلامی Fho3ini369@gmail.com 10031947532846004107 10031947532846004107 No Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات علوم مدیریت و اقتصاد سلامت، پژوهشکده مدیریت سلامت، دانشگاه علوم پزشکی ایران، تهران، ایران Korosh Soltanieh Zanjani کوروش سلطانیه زنجانی koroshsotani@gmail.com 10031947532846004108 10031947532846004108 No Department of Children and Infants, Mofid Hospital, Tehran, Iran گروه کودکان و نوزادان، بیمارستان مفید، تهران، ایران Farhad Lotfi فرهاد لطفی lotfifarhad@gmail.com 10031947532846004109 10031947532846004109 Yes National Center for Health Insurance Research, Tehran, Iran مرکز ملی تحقیقات بیمه سلامت، تهران، ایران