Format

Send to

Choose Destination
Int J Equity Health. 2018 Apr 13;17(1):44. doi: 10.1186/s12939-018-0743-y.

Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey.

Author information

1
Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
2
Health Care Services Management Department, Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran.
3
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
4
Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
5
Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
6
Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. mhmhealth@kmu.ac.ir.

Abstract

BACKGROUND:

Households exposure to catastrophic health expenditure is a valuable measure to monitor financial protection in health sector payments. The present study had two aims: first, to estimate the prevalence and intensity of catastrophic health expenditures (CHE) in Iran. Second, to investigate main factors that influence the probability of CHE.

METHODS:

CHE is defined as an occasion in which a household's out-of-pocket (OOP) spending exceeds 40% of the total income that remains after subtraction of living expenses. This study used the data from eight national repeated cross-sectional surveys on households' income and expenditure. The proportion of households facing CHE, as a prevalence measure, was estimated for rural and urban areas. The intensity of CHE was also calculated using overshoot and mean positive overshoot (MPO) measures. The factors affecting the CHE were also analyzed using logistic random effects regression model. We also used ArcMap 10.1 to display visually disparities across the country.

RESULTS:

An increasing number of Iranians has been subject to catastrophic health care costs over the study period in both rural and urban areas (CHE = 2.57% in 2008 and 3.25% in 2015). In the same period, the overshoot of CHE and the mean positive overshoot ranged from 0.26% to 0.65% and from 12.26% to 20.86%, respectively. The average absolute monetary value of OOP spending per month has been low in rural areas over the years, but the prevalence of CHE has been higher than urban areas. Generally put, rural settlement, higher income, receiving inpatient and outpatient services, and existence of elderly people in the household led to increase in CHE prevalence (p < 0.05). Interestingly, provinces with more limited geographical and cultural accessibility had the lowest CHE.

CONCLUSIONS:

According to the findings, Iran's healthcare system has failed to realize the aim of five-year national development plan regarding CHE prevalence (1% CHE prevalence according to the plan). Therefore, revision of financial health care protection policies focusing on pre-payments seems mandatory. For instance, these policies should extend the interventions that target low-income populations particularly in rural areas, provide more coverage for catastrophic medical services in basic benefit packages, and develop supplementary health insurance.

KEYWORDS:

Financial equity; Health expenditure; Health policy; Iran

PMID:
29653568
PMCID:
PMC5899413
DOI:
10.1186/s12939-018-0743-y
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center