Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
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Objectives: Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019.Methods: Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE.Results: The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (<i>p</i><0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (<i>p</i><0.05).Conclusions: Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.
Abstract
Objectives: Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019.Methods: Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE.Results: The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (<i>p</i><0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (<i>p</i><0.05).Conclusions: Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.
참고문헌 (35)
- "The world health report 2000: health systems: improving performance" (2000)[URL]
- "Global monitoring report on financial protection in health 2021"[URL]
- Saksena P, "Financial risk protection and universal health coverage : evidence and measurement challenges", PLoS Med, 11(9), pp.e1001701~ (2014)[DOI]
- Cylus J, "Catastrophic health spending in Europe : equity and policy implications of different calculation methods", Bull World Health Organ, 96(9), pp.599~609 (2018)[DOI]
- Wagstaff A, "Progress on catastrophic health spending in 133 countries : a retrospective observational study", Lancet Glob Health, 6(2), pp.e169~e179 (2018)[DOI]
- Xu K, "Household catastrophic health expenditure : a multicountry analysis", Lancet, 362(9378), pp.111~117 (2003)[DOI]
- Wei N, "Impact of catastrophic health expenditures on Chinese household consumption", Front Public Health, 9, pp.646494~ (2021)[DOI]
- Doshmangir L, "Determinants of catastrophic health expenditures in Iran : a systematic review and meta-analysis", Cost Eff Resour Alloc, 18, pp.17~ (2020)[DOI]
- Rezaei S, "Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran", J Prev Med Public Health, 52(4), pp.214~223 (2019)[DOI]
- Dorjdagva J, "Catastrophic health expenditure and impoverishment in Mongolia", Int J Equity Health, 15(1), pp.105~ (2016)[DOI]
- Yazdi-Feyzabadi V, "Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015 : a study on Iranian household income and expenditure survey", Int J Equity Health, 17(1), pp.44~ (2018)[DOI]
- van Doorslaer E, "Catastrophic payments for health care in Asia", Health Econ, 16(11), pp.1159~1184 (2007)[DOI]
- Raeissi P, "Investigating the determinants of healthcare expenditures in different healthcare systems", Shiraz E Medical J, 20(9), pp.e86506~ (2019)[DOI]
- "World development indicators"[URL]
- "IRAN (Islamic Republic of): law on the sixth five-year economic, cultural and social development plan"[URL]
- Bordbar S, "The effect of Iran health transformation plan on equity in health financing : a systematic review", Iran J Public Health, 52(9), pp.1844~1854 (2023)[DOI]
- Naghdi S, "The barriers to achieve financial protection in Iranian health system : a qualitative study in a developing country", Ethiop J Health Sci, 27(5), pp.491~500 (2017)[DOI]
- "Iran, Islamic Rep"[URL]
- "Household, expenditure and income: definitions, concepts and statistical survey"[URL]
- "Distribution of health payments and catastrophic expenditures methodology" (2005)[URL]
- Fazaeli AA, "Main determinants of catastrophic health expenditures : a Bayesian logit approach on Iranian household survey data(2010)", Glob J Health Sci, 7(4), pp.335~340 (2015)[DOI]
- Vyas S, "Constructing socio-economic status indices : how to use principal components analysis", Health Policy Plan, 21(6), pp.459~468 (2006)[DOI]
- Wagstaff A, "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam", J Econom, 112(1), pp.207~223 (2003)[DOI]
- Yazdi-Feyzabadi V, "Measuring catastrophic health expenditures and its inequality : evidence from Iran’s health transformation program", Health Policy Plan, 34(4), pp.316~325 (2019)[DOI]
- Hedayati M, "Policy analysis of the protection of Iranian households against catastrophic health expenditures : a qualitative analysis", BMC Health Serv Res, 23(1), pp.445~ (2023)[DOI]
- Zare H, "Health inequalities and development plans in Iran; an analysis of the past three decades(1984-2010)", Int J Equity Health, 13, pp.42~ (2014)[DOI]
- Zandian H, "Effects of Iranian economic reforms on equity in social and healthcare financing : a segmented regression analysis", J Prev Med Public Health, 51(2), pp.83~91 (2018)[DOI]
- Aryankhesal A, "Catastrophic health expenditure in Iran : a review article", Iran J Public Health, 47(2), pp.166~177 (2018)
- Rezaei S, "Catastrophic healthcare expenditures among Iranian households : a systematic review and meta-analysis", Int J Hum Rights Healthc, 12(2), pp.105~115 (2018)[DOI]
- Global Burden of Disease Health Financing Collaborator Network, "Past, present, and future of global health financing : a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050", Lancet, 393(10187), pp.2233~2260 (2019)[DOI]
- "Financial protection"[URL]
- Chang EJ, "The impact of public transfer income on catastrophic health expenditures for households with disabilities in Korea", J Prev Med Public Health, 56(1), pp.67~76 (2023)[DOI]
- Hernández-Vásquez A, "Measuring out-of-pocket payment, catastrophic health expenditure and the related socioeconomic inequality in Peru : a comparison between 2008 and 2017", J Prev Med Public Health, 53(4), pp.266~274 (2020)[DOI]
- Eze P, "Factors associated with catastrophic health expenditure in sub-Saharan Africa : a systematic review", PLoS One, 17(10), pp.e0276266~ (2022)[DOI]
- Azzani M, "Determinants of household catastrophic health expenditure : a systematic review", Malays J Med Sci, 26(1), pp.15~43 (2019)[DOI]