Postoperative kinesiophobia in patients undergoing video-assisted thoracoscopic lung surgery: a longitudinal study.

Spinal cord injury (SCI) is a harmful neurological disorder. It can induce many substantial impairments in somatosensory and autonomic functions. According to the World Health Organization, SCIs impact between 13 and 33 million individuals in the world, and around 250,000 to 500,000 new cases emerge each year. Over the last 30 years, its global prevalence has increased from 236 to 1,298 cases per million people. The data indicates that the incidence rate of traumatic SCIs in Iran is approximately 9 cases per 100,000 individuals. Furthermore, the prevalence of SCIs in Iran is about 318.45 cases per million people. Based on these reported data, SCI affects a large number of patients. To receive medical services, patients are required to pay fees such as physical rehabilitation services, medicine, and psychiatric care services. The amount of money that is directly paid by individuals is called out-of-pocket (OOP). The analysis of OOP plays a key role in health system policies and the performance of insurance. A lower amount of OOP reflects efficiency in the healthcare system. Based on the statistics from the World Health Organization, the rate of OOP for health is around 24% in the world. In many developing countries, OOP is the major way of financing healthcare, and this percentage increases to up to 50% in these countries. According to the World Health Report, equity in health systems, responsiveness and efficiency, and fairness in healthcare financing are essential goals. Understanding the numbers of OOP expenses helps us achieve these goals. For instance, OOP accounts for 67% of total healthcare system expenses in Pakistan, 44.9% in the Republic of Moldova, and 62.6% in India. In Ethiopia, many families are responsible for covering their own healthcare costs, which poses a significant health challenge. These OOP expenses account for approximately one-third (34%) of all healthcare spending, making it one of the highest rates in the world. This situation arises because a large number of people lack sufficient health insurance. Iran’s National Health Accounts show that OOP payments by families account for about 55% of the total financial resources used to fund the health system. Patients with SCIs experience long-term disabilities; as a result, these patients are frequent users of medical services. Therefore, it is important to gather detailed information about OOP payments. This information will provide health policymakers with a better understanding, helping them to make better decisions for planning and distributing resources effectively, especially for patients who are unable to afford the costs of treatment. In developing countries, healthcare resources are often insufficient, making it difficult for individuals to access the services they need. Furthermore, statistics show that the percentage of the global population spending more than 10% of their household income on healthcare rose from 9.4% in 2000 to 12.7% in 2015, totaling approximately 927 million people. When the payment system relies on OOP expenses, access to healthcare services becomes heavily influenced by individuals' economic status and income. One of the primary goals of international health policy is to implement a more equitable payment system than OOP expenses. When patients are unable to afford treatment costs, they may resort to cheaper and less effective options, such as traditional medicine. Alternatively, they might abandon their treatment altogether or fail to complete it. Furthermore, direct OOP payments for healthcare negatively impact how households allocate their income towards essential needs like food, housing, clothing, education, and other essential living necessities. As previously mentioned, SCI is a long-term condition that imposes significant financial burdens on affected patients. Understanding the OOP expenses incurred by patients with SCI is essential for policymakers to enhance funding and treatment processes for this population. This study aims to quantify OOP payments for healthcare services, particularly focusing on rehabilitation, psychiatric care, and medication among SCI patients in Iran. Additionally, it will analyze how these costs impact healthcare access and treatment adherence, while also addressing the equity challenges present in the current healthcare system. This was a cross sectional study. Data of International Spinal Cord Injury Survey for Iran (InSCI-IR) in 2023 was used in the study. The survey was conducted in Guilan province, Iran and contained information about 191 SCI patients who were faced with untreated paraplegia and tetraplegia. The data covered near 60% of all registered SCI patients in the province. InSCI-IR data were based on the health information system of Poursina Hospital of Rasht, a referral center for traumatic SCI cases across Guilan Province. The registry includes comprehensive clinical and demographic data on patients with traumatic spinal injuries from an initial pool of 1,