Financial Barriers to Access to Health Services for Adult People with Disability in Iran: The Challenges for Universal Health Coverage
Background: Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran.
Methods: In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran.
Results: We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD).
Conclusion: Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD.
2. Goddard M, Smith P (2001). Equity of access to health care services: Theory and evidence from the UK. Soc Sci Med, 53(9):1149-62.
3. Baru R, Acharya A, Acharya S et al (2010). Inequities in access to health services in India: caste, class and region. Econ Polit Wkly, 45(38):49-58.
4. Callahan ST, Cooper WO (2006). Access to health care for young adults with disabling chronic conditions. Arch Pediatr Adolesc Med, 160(2):178-82.
5. Srivastava D, McGuire A (2015). Patient access to health care and medicines across low-income countries. Soc Sci Med, 133:21-7.
6. Soltani S, Khosravi B, Salehiniya H (2015). Prevalence of Disability in Iran. Iran J Public Health, 44(10):1436-7.
7. Soltani S, Khosravi B, Salehiniya H (2015). Prevalence of intellectual disability in Iran: Toward a new conceptual framework in data collection. J Res Med Sci, 20(7):714-5.
8. Islamic Parliament Research Center (2003 .( http://rc.majlis.ir/fa/law/show/94044
9. Abdi K, Arab M, Rashidian A et al (2015). Exploring Barriers of the Health System to Rehabilitation Services for People with Disabilities in Iran: A Qualitative Study. Electron Physician, 7(7):1476-85.
10. Mobaraki A, Zadehbagheri G (2003). Comaparision of knowledge and attitude of mothers with mentally retarded children with those without mentally retarded children in Gachsaran. Armaghan Danesh, 8(31):89-97.
11. Vameghi R H-BM, Hatami-Zadeh N, Biglarian A, Rah-Chamani MR (2014). Factors Affecting Delayed Referral for Speech Therapy in Iranian children with Speech and Language Disorder. J Rehab, 14(S2):68-77.
12. Khosravi B, Soltani S, Javan-Noughabi J, Faramarzi A (2017). Health care expenditure in the Islamic Republic of Iran versus other high spending countries. Med J Islam Repub Iran, 31:71.
13. Arsang JS, Amani F, Jafari KT et al (2015). The Level of Availability and Use of Oral and Dental Health Services in 6-7 Years Old Children, Qom, Iran. Qom Univ Med Sci J, 9(4): 55-63.
14. Layton N, Hubbard W, Burton J, Kuna A (2016). Quality, Choice and Outcomes in Assistive Technology (AT) Equipment Funding Schemes: A Procurement Case Study. Health Syst Policy Res, 3:1.
15. World Health Organization (2010). The world health report: health systems financing: the path to universal coverage. WHO Press, Geneva, pp: 10-14.
16. Barghi S, Foroughan M, Hosseini M, Farzi M (2013). Comparing job stress and related factors between welfare organization’s employees with and without physical disability in Tehran. Journal of Health Promotion Management, 2(3):56-65.
17. Ebadi A, HashemiSheykhShabani E, Ghasemzadeh R et al (2013). Identifying the Barriers to Employment of People with Physical Disabilities and its Implications for Rehabilitation policy makers. Middle Eastern Journal of Disability Studies, 3(2):9-22.
18. Saunders P (2007). The costs of disability and the incidence of poverty. Australian Journal of Social Issues, 42(4):461-480.
19. Sharifi A, Kamali M, Chabok A (2014). Rehabilitation Needs of People with Cerebral Palsy: a qualitative Study. Med J Islam Repub Iran, 28:16.
20. Soltani Sh, Takian A, Akbari Sari A et al (2017). Cultural barriers in access to healthcare services for people with disability in Iran: A qualitative study. Med J Islam Repub Iran, 31:51.
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