背景:了解寻求医疗保健的行为并检查医疗支出可以帮助确定获得医疗保健的可能障碍,并指导更有效和更具包容性的医疗保健系统。这项研究旨在评估埃尔比勒人口样本中的医疗寻求行为和自付医疗支出,伊拉克。
方法:我们在埃尔比勒进行了这项横断面研究,伊拉克库尔德斯坦地区,2023年10月至12月。414名成年人的便利样本完成了一项自我管理的在线调查。收集了以下数据:最近患病,社会人口统计学特征,接受的医疗保健类型,和医疗保健的成本。
结果:报告的最常见的健康状况是传染病(16.3%),肌肉骨骼问题(13.1%),和非传染性疾病(12.7%)。大约85%的有健康状况需要护理的患者寻求医疗保健;大多数去过私人诊所(46.3%)和私人医院(18.6%)。以美元计的自付医疗总支出中位数为117.3(四分位距(IQR)=45.6-410.0)。首次访问私人医疗机构的参与者的总费用中位数(135.5美元,IQR=57.3-405.6)比首次访问公共设施的参与者(76.8美元,IQR=16.1-459.7)大得多。≥60年的参与者花费的时间明显多于<14年的参与者(332美元,95%CI=211-453,p<0.001)。已婚参与者的支出明显高于未婚参与者(97美元,95%CI=1至192,p=0.047)。非传染性疾病的卫生支出明显高于传染性疾病(232美元,95%CI=96-368,p=0.001)。在调整协变量后,年龄≥60岁与更高的支出独立相关(305美元,95%CI=153-457,p<0.001).
结论:大多数参与者寻求正规医疗服务,更喜欢私营部门。从私人设施寻求护理的费用比从公共设施寻求护理的费用高得多,这表明获得医疗保健的潜在障碍,特别是负担能力。调查结果强调了评估现有医疗保健政策以提高有效性并确定需要改进的领域的重要性。这项研究可以帮助政策制定者和医疗保健提供者设计有效的干预措施,有效地分配资源,改善医疗保健服务。
BACKGROUND: Understanding healthcare-seeking behavior and examining health expenditures can help determine possible barriers to accessing healthcare and direct more effective and inclusive healthcare systems. This study aimed to evaluate healthcare-seeking behavior and out-of-pocket healthcare expenditure in a sample of the population in Erbil, Iraq.
METHODS: We conducted this cross-sectional study in Erbil, Kurdistan Region of Iraq, from October to December 2023. A convenience sample of 414 adults completed a self-administered online survey. The following data were collected: recent illness, sociodemographic characteristics, type of healthcare received, and cost of healthcare.
RESULTS: The most common health conditions reported were communicable diseases (16.3%), musculoskeletal problems (13.1%), and noncommunicable diseases (12.7%). Approximately 85% of patients with health conditions requiring care sought healthcare; most visited private clinics (46.3%) and private hospitals (18.6%). The median total out-of-pocket healthcare expenditure in US dollars was 117.3 (interquartile range (IQR) = 45.6-410.0). The median total cost was much greater for participants who first visited a private health facility (USD 135.5, IQR = 57.3-405.6) than those who first visited a public facility (USD 76.8, IQR = 16.1-459.7). Participants ≥ 60 years spent significantly more than those < 14 years (USD 332, 95% CI = 211-453, p < 0.001). Evermarried participants spent significantly more than unmarried (USD 97, 95% CI = 1 to 192, p = 0.047). Health expenditures were significantly greater for noncommunicable diseases than infectious diseases (USD 232, 95% CI = 96-368, p = 0.001). After adjusting for covariates, age ≥ 60 years was independently associated with higher spending (USD 305, 95% CI = 153-457, p < 0.001).
CONCLUSIONS: Most participants sought care from formal health services, preferring the private sector. Seeking care from private facilities incurred significantly higher costs than seeking care from public ones, which suggests potential barriers to accessing healthcare, particularly affordability. The findings underscore the importance of evaluating existing healthcare policies to enhance effectiveness and identify areas for improvement. This study can help policymakers and healthcare providers design effective interventions, allocate resources efficiently, and improve healthcare delivery.