본문 바로가기
KERD
논문KCI 등재

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis

2

조회

0

다운로드

3

인용

0

참고문헌

키워드

초록

Objectives: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Abstract

Objectives: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

참고문헌 (39)

  1. Gerstl S, "Who can afford health care? Evaluating the socio-economic conditions and the ability to contribute to health care in a post-conflict area in DR Congo", PLoS One, 8(10), pp.e77382~ (2013)[DOI]
  2. Evans DB, "Health systems financing and the path to universal coverage", Bull World Health Organ, 88(6), pp.402~ (2010)[DOI]
  3. Khan JA, "Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh-an estimation of financial risk protection of universal health coverage", Health Policy Plan, 32(8), pp.1102~1110 (2017)[DOI]
  4. Hajizadeh M, "Equity of health care financing in Iran: the effect of extending health insurance to the uninsured", Oxf Dev Stud, 38(4), pp.461~476 (2010)[DOI]
  5. Mehrolhassani M, "Total health expenditures and proportion of out-of-pocket payments in Iranian provinces; 2008-2014", Iran J Epidemiol, 12(5), pp.1~12 (2017)
  6. Takian A, "The experience of purchaser-provider split in the implementation of family physician and rural health insurance in Iran: an institutional approach", Health Policy Plan, 30(10), pp.1261~1271 (2015)[DOI]
  7. Hajizadeh M, "Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?", Int J Health Care Finance Econ, 11(4), pp.267~285 (2011)[DOI]
  8. Yazdi Feyzabadi V, "The trend of impoverishing effects of out-of-pocket health expenditure in Iranian provinces in 2008-2014", Iran J Epidemiol, 12(5), pp.20~31 (2017)
  9. Mostafavi H, "Inequitable distribution of specialists and hospital beds in west Azerbaijan province", J Allied Med Sch Tehran Univ Med Sci, 9(1), pp.55~66 (2015)
  10. Zandiyan H, "Measuring inequality of distribution of health resources: a case study", Payesh, 11(6), pp.799~805 (2012)
  11. Yazdi Feyzabadi V, "Incidence and intensity of catastrophic health expenditures in Iranian provinces; 2008-2014", Iran J Epidemiol, 12(5), pp.40~54 (2017)
  12. Davari M, "Health care financing in iran; is privatization a good solution?", Iran J Public Health, 41(7), pp.14~23 (2012)
  13. Kavosi Z, "Inequality in household catastrophic health care expenditure in a low-income society of Iran", Health Policy Plan, 27(7), pp.613~623 (2012)[DOI]
  14. "Iran-the chronicles of the subsidy reform"[URL]
  15. Salehi-Isfahani D, "The reform of energy subsidies in Iran: the role of cash transfers", Emerg Mark Financ Trade, 51(6), pp.1144~1162 (2015)[DOI]
  16. Abbasian E, "Targeted communication of energy subsidies and social welfare through economic growth", Soc Welf, 12(44), pp.143~173 (2012)
  17. Zamanzadeh H, "Targeted subsidies: achievements, challenges and costs", Tazehaye Egtesad, 9(133), pp.108~116 (2011)
  18. Zandian H, "Contribution of targeted subsidies law to the equity in healthcare financing in Iran: exploring the challenges of policy process", Electron Physician, 8(2), pp.1892~1903 (2016)
  19. Pourasghari H, "Analysis of equality in Iranian household healthcare payments during Iran's fourth development program", Electron Physician, 8(7), pp.2645~2649 (2016)[DOI]
  20. Doshmangir L, "Effects of targeted subsidies policy on health behavior in Iranian Households: a qualitative study", Iran J Public Health, 44(4), pp.570~579 (2015)
  21. Wagner AK, "Segmented regression analysis of interrupted time series studies in medication use research", J Clin Pharm Ther, 27(4), pp.299~309 (2002)
  22. Giles DE, "Calculating a standard error for the Gini coefficient:some further results", Oxf Bull Econ Stat, 66(3), pp.425~433 (2004)
  23. Yusuf AA, "Fuel taxes and the poor: the distributional effects of gasoline taxation and their implications for climate policy", pp.171~180 (2012), RFF Press
  24. "Analyzing health equity using household survey data a guide to techniques and their implementation"[URL]
  25. O'Donnell OA, "Analyzing health equity using household survey data: a guide to techniques and their implementation", pp.1~165 (2008)
  26. Paya A, "The state of social progress of Islamic societies: social, economic, political, and ideological challenges", pp.211~235 (2016), Springer
  27. Ramsay CR, "Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies", Int J Technol Assess Health Care, 19(4), pp.613~623 (2003)[DOI]
  28. Hamilton JD, "Time series analysis", pp.571~ (1994), Princeton University Press
  29. "Recent developments in Iran's energy subsidy reforms"[URL]
  30. Graeff P, "The impact of economic freedom on corruption: different patterns for rich and poor countries", Eur J Polit Econ, 19(3), pp.605~620 (2003)[DOI]
  31. Heshmati A, "The world distribution of income and income inequality: a review of the economics literature", J World-Syst Res, 12(1), pp.61~107 (2006)[DOI]
  32. Vincens N, "Income inequality, economic growth and stroke mortality in Brazil: longitudinal and regional analysis 2002-2009", PLoS One, 10(9), pp.e0137332~ (2015)[DOI]
  33. Farzanegan MR, "The effects of oil price shocks on the Iranian economy", Energy Econ, 31(1), pp.134~151 (2009)[DOI]
  34. "Inflation and income inequality in developed economies"[URL]
  35. "Equity of health care financing in Iran"[URL]
  36. Rezaei S, "Determinants of healthcare expenditures in Iran: evidence from a time series analysis", Med J Islam Repub Iran, 30, pp.313~ (2016)
  37. Munge K, "The progressivity of health-care financing in Kenya", Health Policy Plan, 29(7), pp.912~920 (2014)[DOI]
  38. Cabieses B, "Did socioeconomic inequality in self-reported health in Chile fall after the equity-based healthcare reform of 2005? A concentration index decomposition analysis", PLoS One, 10(9), pp.e0138227~ (2015)[DOI]
  39. Hu TW, "The effects of economic reform on health insurance and the financial burden for urban workers in China", Health Econ, 8(4), pp.309~321 (1999)[DOI]

관련 논문AI추천

이 간행물의 다른 논문 (6건)