fa میزان استفاده بیماران بستری طبقات مختلف اجتماعی و اقتصادی از یارانه سلامت در بیمارستان‌های دولتی شهرستان بابل در سال 1397 مديريت خدمات بهداشتي و درماني Health Services Management پژوهشي-کامل Research(Original) <p dir="RTL" style="margin: 0px; text-align: justify; line-height: 115%; text-indent: 28.35pt; unicode-bidi: embed; direction: rtl;"><span style="font-size:12pt"><span style="line-height:89%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span b="" koodak="" lang="FA" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">سابقه</span></span></span><span b="" koodak="" lang="AR-SA" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt"> و هدف:</span></span></span> <span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black">میزان دسترسی به خدمات سلامت و توزیع بهینه و عادلانه آن</span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">‌</span></span></span><span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black">ها در سطح کشور و به</span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">‌</span></span></span><span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black">ویژه مناطق محروم، از اهداف بسیار مهم سیستم‌های سلامت است.</span></span><span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black"> هدف این مطالعه بررسی میزان استفاده از یارانه سلامت در طبقات مختلف اجتماعی و اقتصادی در بیمارستان‌های دولتی شهرستان بابل بود.</span></span><span b="" lang="FA" style="font-family:" zar=""><span style="color:#0e101a"></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:89%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:89%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">مواد و روش</span></span></span></span><span lang="FA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">ها:</span></span></span></span> <span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">این مطالعه کاربردی بصورت مقطعی در بیمارستان‌های دولتی دانشگاه علوم پزشکی بابل درسال 1397</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"> <span style="letter-spacing:-.1pt">انجام شد. جامعه آماری شامل 700 نفراز بیماران مراجعه‌کننده به این بیمارستان</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">ها بود که به روش تصادفی ساده انتخاب شدند.</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"> ابزار گردآوری داده‌ها چک لیست مبتنی بر صورتحساب مالی بیماران وپرسشنامه محقق ساخته بود. در نهایت داده‌ها با نرم‌افزار </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:89%"><span style="color:black">SPSS</span></span></span><span lang="FA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"> نسخه 22 و استفاده از </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:89%"><span style="color:black">Mann Whitney test</span></span></span><span lang="FA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">&nbsp; و </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:89%"><span style="color:black">Kruskal Wallis test</span></span></span><span lang="FA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"> برای مقایسه مقادیر در گروه‌ها تجزیه و </span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">تحلیل شدند.</span></span></span><span lang="FA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:89%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:89%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">یافته</span></span></span></span><span lang="FA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">ها:</span></span></span></span> <span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">میزان یارانه بیماران دارای وضعیت اجتماعی متوسط از دو گروه خوب و ضعیف بیش</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">تر بود. بیش</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">ترین تخفیف</span></span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"> در پرداخت مربوط به طبقه اجتماعی خوب و سپس متوسط و ضعیف بود، اما این تفاوت‌ها به لحاظ آماری معنی‌دار نبودند (</span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">0/50</span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:89%"><span style="color:black">></span></span></span><span dir="LTR" lang="EN-GB" style="font-size:10.0pt"><span style="line-height:89%"><span style="color:black">P</span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">). همچنین یارانه بیماران با وضعیت اقتصادی خوب (450000 تومان) بیش</span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">‌</span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">تر از بیماران با وضعیت اقتصادی پایین‌تر (430000 تومان)</span></span></span><span lang="FA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"> بود که از نظر آماری</span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"> معنی‌دار بوده است (</span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">0/50</span></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:89%"><span style="color:black">></span></span></span><span dir="LTR" lang="EN-GB" style="font-size:10.0pt"><span style="line-height:89%"><span style="color:black">P</span></span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">).</span></span></span><span lang="FA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:89%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:89%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">استنتاج:</span></span></span></span> <span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black">یافته</span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">‌</span></span></span><span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black">ها نشان داد استفاده بیماران از یارانه سلامت و تخفیف بیمارستانی متناسب با طبقه اجتماعی، اقتصادی آنان نبوده است و اغلب بیمارانی که از نظر</span></span> <span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black">این ویژگی‌ها شرایط بهتری داشتند، بهره بیش</span></span><span lang="AR-SA" style="line-height:89%"><span b="" style="font-family:" zar=""><span style="color:black">‌</span></span></span><span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black">تری برده‌اند. </span></span><span b="" lang="AR-SA" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt"></span></span></span></span></span></span></span></span></span></span><br> <span lang="AR-SA" style='margin: 0px; line-height: 115%; font-family: "B Zar"; font-size: 11pt;'></span></p> <p style="margin: 0px; line-height: 115%; text-indent: 14.2pt;"><span style="font-size:12pt"><span style="line-height:135%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:135%"><span arial="" style="font-family:"><span style="letter-spacing:-.2pt">Background and purpose:</span></span></span></span></b><span lang="EN" style="font-size:10.0pt"><span style="line-height:135%"> Equitable access to health services and their fair distribution in the country, especially in deprived areas, are among the major goals of health systems. The aim of this study was to investigate the amount of health insurance subsidies in different socio-economic classes in public hospitals in Babol, Iran.</span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:135%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:135%"><span arial="" style="font-family:">Materials and methods:</span></span></span></b><b> </b><span lang="EN" style="font-size:10.0pt"><span style="line-height:135%">This cross-sectional applied study was performed in hospitals affiliated with Babol University of Medical Sciences in 2018. The statistical population consisted of 700 patients selected by simple random sampling. Data were collected using a checklist based on patient statements and a researcher-made questionnaire. SPSS V22 was used to analyze the data applying Mann Whitney and Kruskal Wallis test. </span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:135%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:135%"><span arial="" style="font-family:">Results:</span></span></span></b><b> </b><span lang="EN" style="font-size:10.0pt"><span style="line-height:135%">The amount of health insurance subsidies for patients of middle social class was higher than </span></span><span style="font-size:10.0pt"><span style="line-height:135%">other</span></span><span lang="EN" style="font-size:10.0pt"><span style="line-height:135%"> two groups (good and lower social classes). </span></span><span style="font-size:10.0pt"><span style="line-height:135%">The most discount on medical bills were offered to good-social class patients and then to patients of middle and lower classes</span></span><span lang="EN" style="font-size:10.0pt"><span style="line-height:135%"> (P<0.05). Also, health insurance subsidy paid to patients with good economic status (450,000 Tomans) was higher than patients with poor economic status (430,000 Tomans) (P<0.05).</span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:135%"><span style="vertical-align:top"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:135%"><span arial="" style="font-family:">Conclusion:</span></span></span></b> <span lang="EN" style="font-size:10.0pt"><span style="line-height:135%">Current study showed that health subsidies and medical bill discounts were not commensurate with patients&rsquo; social and economic </span></span><span lang="EN-GB" style="font-size:10.0pt"><span style="line-height:135%">status</span></span><span lang="EN" style="font-size:10.0pt"><span style="line-height:135%">. In fact, patients who had good conditions in terms of these characteristics, benefited more than </span></span><span style="font-size:10.0pt"><span style="line-height:135%">other groups.<i></i></span></span></span></span></span></span><br> &nbsp;</p> واژگان کلیدی: یارانه, یارانه سلامت, طبقات اجتماعی- اقتصادی, بیمارستان‌های عمومی subsidy, health subsidies, socio-economic groups, public hospitals 140 149 http://jmums.mazums.ac.ir/browse.php?a_code=A-11-12034-1&slc_lang=fa&sid=1 Samad Rohani صمد روحانی samad.rouhani@gmail.com 1003194753284600148458 1003194753284600148458 No Associate Professor, Department of Public Health, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran دانشیار، اقتصاد بهداشت، گروه بهداشت عمومی، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران Khadije Safizade خدیجه صفی‌زاده 1003194753284600148463 1003194753284600148463 No PhD Student in Health Services Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran دانشجوی دکتری تخصصی مدیریت خدمات بهداشتی درمانی، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران Mohammad Ali Jahani محمدعلی جهانی drmajahani@yahoo.com 1003194753284600148459 1003194753284600148459 No Associate Professor, Research Center for Social Factors Affecting Health, Institute of Health, Babol University of Medical Sciences, Iran دانشیار، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، ایران Noureddin Mousavinasab نورالدین موسوی نسب snmn1337@yahoo.com 1003194753284600148460 1003194753284600148460 No Associate Professor, Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran دانشیار، گروه آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مازندران، ساری، ایران Fatemeh Abdolahi فاطمه عبدالهی abdollahizagh@gmail.com 1003194753284600148461 1003194753284600148461 No Associate Professor, Department of Public Health, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran دانشیار، گروه بهداشت عمومی، دانشگاه علوم پزشکی مازندران، ساری، ایران Fatemeh Fakhraei فاطمه فخرایی fatemehfakhraei@yahoo.com 1003194753284600148462 1003194753284600148462 Yes MSc Student in Health Services Management, Mazandaran University of Medical Sciences, Sari, Iran کارشناسی ارشد مدیریت خدمات بهداشتی درمانی، دانشگاه علوم پزشکی مازندران، ساری، ایران