Household Financial Burden Associated with Out-of-pocket Payments for Healthcare in Iran: Insights from a Cross-sectional Survey

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2024 Sep 13

PMID 39272081

Authors

Satar Rezaei

Maryam Karimi

Shahin Soltani

Eshagh Barfar

Mohammad Ali Mohammadi Gharehghani

Abbas Badakhshan

Nasim Badiee

Mohsen Pakdaman

Heather Brown

Affiliations

Soon will be listed here.

Abstract

Background: One of the key functions and ultimate goals of health systems is to provide financial protection for individuals when using health services. This study sought to evaluate the level of financial protection and its inequality among individuals covered by the Social Security Organization (SSO) health insurance between September and December 2023 in Iran.

Methods: We collected data on 1691 households in five provinces using multistage sampling to examine the prevalence of catastrophic healthcare expenditure (CHE) at four different thresholds (10%, 20%, 30%, and 40%) of the household's capacity to pay (CTP). Additionally, we explored the prevalence of impoverishment due to health costs and assessed socioeconomic-related inequality in OOP payments for healthcare using the concentration index and concentration curve. To measure equity in out-of-pocket (OOP) payments for healthcare, we utilized the Kakwani progressivity index (KPI). Furthermore, we employed multiple logistic regression to identify the main factors contributing to households experiencing CHE.

Findings: The study revealed that households in our sample allocated approximately 11% of their budgets to healthcare services. The prevalence of CHE at the thresholds of 10%, 20%, 30%, and 40% was found to be 47.1%, 30.1%, 20.1%, and 15.7%, respectively. Additionally, we observed that about 7.9% of the households experienced impoverishment due to health costs. Multiple logistic regression analysis indicated that the age of the head of the household, place of residence, socioeconomic status, utilization of dental services, utilization of medicine, and province of residence were the main factors influencing CHE. Furthermore, the study demonstrated that while wealthy households spend more money on healthcare, poorer households spend a larger proportion of their total income to healthcare costs. The KPI showed that households with lower total expenditures had higher OOP payments relative to their CTP.

Conclusion: The study findings underscore the need for targeted interventions to improve financial protection in healthcare and mitigate inequalities among individuals covered by SSO. It is recommended that these interventions prioritize the expansion of coverage for dental services and medication expenses, particularly for lower socioeconomic status household.

References

Gheinali Z, Moshiri E, Tavani M, Haghi M, Gharibi F . Catastrophic health expenditures in hospitalized patients with delta variant of COVID-19: A cross-sectional study. Health Promot Perspect. 2023; 13(1):68-76. PMC: 10257567. DOI: 10.34172/hpp.2023.09. View

Rezaei S, Woldemichael A, Ebrahimi M, Ahmadi S . Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect. J Egypt Public Health Assoc. 2020; 95(1):29. PMC: 7606373. DOI: 10.1186/s42506-020-00055-w. View

Hedayati M, Masoudi Asl I, Maleki M, Fazaeli A, Goharinezhad S . The Variations in Catastrophic and Impoverishing Health Expenditures, and Its Determinants in Iran: A Scoping Review. Med J Islam Repub Iran. 2023; 37:44. PMC: 10329513. DOI: 10.47176/mjiri.37.44. View

Proano Falconi D, Bernabe E . Determinants of catastrophic healthcare expenditure in Peru. Int J Health Econ Manag. 2018; . DOI: 10.1007/s10754-018-9245-0. View

Ghoddoosinejad J, Jannati A, Gholipour K, Baghban Baghestan E . Households encountering with catastrophic health expenditures in Ferdows, Iran. J Egypt Public Health Assoc. 2014; 89(2):81-4. DOI: 10.1097/01.EPX.0000451789.21421.61. View

Piroozi B, Mohamadi-Bolbanabad A, Moradi G, Safari H, Ghafoori S, Zarezade Y . Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality. Diabetes Metab Syndr Obes. 2020; 13:2865-2876. PMC: 7450415. DOI: 10.2147/DMSO.S263571. View

Mehdizadeh P, Daniyali H, Meskarpour-Amiri M, Dopeykar N, Uzi H . Catastrophic and impoverishing health expenditures and it's affecting factors among health staffs in Iran: A case study in Tehran. Med J Islam Repub Iran. 2020; 33:120. PMC: 6983491. DOI: 10.34171/mjiri.33.120. View

Wagstaff A . The concentration index of a binary outcome revisited. Health Econ. 2011; 20(10):1155-60. DOI: 10.1002/hec.1752. View

Davari M, Haycox A, Walley T . The Iranian health insurance system; past experiences, present challenges and future strategies. Iran J Public Health. 2012; 41(9):1-9. PMC: 3494208. View

10.

Wagstaff A, van Doorslaer E . Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. Health Econ. 2003; 12(11):921-34. DOI: 10.1002/hec.776. View

11.

Shokri A, Mohamadi Bolbanabad A, Rezaei S, Moradi G, Piroozi B . Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey. Health Sci Rep. 2023; 6(4):e1199. PMC: 10102736. DOI: 10.1002/hsr2.1199. View

12.

Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F, Hosseinpour A . Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan. 2012; 27(7):613-23. DOI: 10.1093/heapol/czs001. View

13.

Kazemi-Galougahi M, Dadgar E, Kavosi Z, Majdzadeh R . Correction to: Increase of catastrophic health expenditure while it does not have socio-economic anymore; finding from a district on Tehran after recent extensive health sector reform. BMC Health Serv Res. 2019; 19(1):702. PMC: 6794745. DOI: 10.1186/s12913-019-4542-y. View

14.

Giang N, Vinh N, Phuong H, Thang N, Oanh T . Household financial burden associated with healthcare for older people in Viet Nam: a cross-sectional survey. Health Res Policy Syst. 2022; 20(Suppl 1):112. PMC: 9706832. DOI: 10.1186/s12961-022-00913-3. View

15.

Xu Y, Gao J, Zhou Z, Xue Q, Yang J, Luo H . Measurement and explanation of socioeconomic inequality in catastrophic health care expenditure: evidence from the rural areas of Shaanxi Province. BMC Health Serv Res. 2015; 15:256. PMC: 4490607. DOI: 10.1186/s12913-015-0892-2. View

16.

. Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet. 2017; 389(10083):1981-2004. PMC: 5440770. DOI: 10.1016/S0140-6736(17)30874-7. View

17.

Saksena P, Hsu J, Evans D . Financial risk protection and universal health coverage: evidence and measurement challenges. PLoS Med. 2014; 11(9):e1001701. PMC: 4171370. DOI: 10.1371/journal.pmed.1001701. View

18.

Edmonds S, Hajizadeh M . Assessing progressivity and catastrophic effect of out-of-pocket payments for healthcare in Canada: 2010-2015. Eur J Health Econ. 2019; 20(7):1001-1011. DOI: 10.1007/s10198-019-01074-x. View

19.

Waters H, Anderson G, Mays J . Measuring financial protection in health in the United States. Health Policy. 2004; 69(3):339-49. DOI: 10.1016/j.healthpol.2004.01.003. View

20.

Ghiasvand H, Abolghasem Gorji H, Maleki M, Hadian M . Catastrophic Health Expenditure Among Iranian Rural and Urban Households, 2013 - 2014. Iran Red Crescent Med J. 2015; 17(9):e30974. PMC: 4601211. DOI: 10.5812/ircmj.30974. View