Measuring and Decomposing Socioeconomic Inequality in Catastrophic Healthcare Expenditures in Iran
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Objectives: Equity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran. Methods: A total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran. Results: The prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran. Conclusions: This study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.
Abstract
Objectives: Equity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran. Methods: A total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran. Results: The prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran. Conclusions: This study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.
참고문헌 (35)
- Buigut S, "Catastrophic health expenditure and its determinants in Kenya slum communities", Int J Equity Health, 14, pp.46~ (2015)
- Li Y, "Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China : policy implications of universal health insurance", Bull World Health Organ, 90(9), pp.664~671 (2012)
- Limwattananon S, "Catastrophic and poverty impacts of health payments : results from national household surveys in Thailand", Bull World Health Organ, 85(8), pp.600~606 (2007)
- Islam MR, "Inequalities in financial risk protection in Bangladesh : an assessment of universal health coverage", Int J Equity Health, 16(1), pp.59~ (2017)
- "The world health report 2000: health systems-improving performance"[URL]
- Elani HW, "Socio-economic inequalities and oral health in Canada and the United States", J Dent Res, 91(9), pp.865~870 (2012)
- Wagstaff A, "Catastrophe and impoverishment in paying for health care : with applications to Vietnam 1993-1998", Health Econ, 12(11), pp.921~934 (2003)
- "Designing health financing systems to reduce catastrophic health expenditure" (2005)[URL]
- Global Burden of Disease Health Financing Collaborator Network, "Spending on health and HIV", AIDS: domestic health spending and development assistance in 188 countries, 1995-2015, 2018, pp.391(10132), 1799~1829
- Global Burden of Disease Health Financing Collaborator Network, "Trends in future health financing and coverage : future health spending and universal health coverage in 188 countries, 2016-40", Lancet, 391(10132), pp.1783~1798 (2018)
- Global Burden of Disease Health Financing Collaborator Network, "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, 389(10083), pp.1981~2004 (2017)
- Rezaei S, "Catastrophic healthcare expenditures among Iranian households : a systematic review and meta-analysis", Int J Hum Rights Healthc, 12(2), pp.105~115 (2019)
- Hajizadeh M, "Out-of-pocket expenditures for hospital care in Iran : who is at risk of incurring catastrophic payments", Int J Health Care Finance Econ, 11(4), pp.267~285 (2011)
- Ghiasvand H, "Hospitalization and catastrophic medical payment : evidence from hospitals located in Tehran", Arch Iran Med, 17(7), pp.507~513 (2014)
- Kavosi Z, "Inequality in household catastrophic health care expenditure in a low-income society of Iran", Health Policy Plan, 27(7), pp.613~623 (2012)
- Moghadam MN, "Iranian household financial protection against catastrophic health care expenditures", Iran J Public Health, 41(9), pp.62~70 (2012)
- Xu K, "Household catastrophic health expenditure : a multicountry analysis", Lancet, 362(9378), pp.111~117 (2003)
- Gotsadze G, "Household catastrophic health expenditure : evidence from Georgia and its policy implications", BMC Health Serv Res, 9, pp.69~ (2009)
- Xu K, "Protecting households from catastrophic health spending", Health Aff(Millwood), 26(4), pp.972~983 (2007)
- "Health systems performance assessment: debates, methods and empiricism" (2003)[URL]
- Yardim MS, "Catastrophic health expenditure and impoverishment in Turkey", Health Policy, 94(1), pp.26~33 (2010)
- "Distribution of health payments and catastrophic expenditures: methodology" (2005)[URL]
- Vyas S, "Constructing socio-economic status indices : how to use principal components analysis", Health Policy Plan, 21(6), pp.459~468 (2006)
- Kolenikov S, "Socioeconomic status measurement with discrete proxy variables : is principal component analysis a reliable answer", Rev Income Wealth, 55(1), pp.128~165 (2009)
- Koolman X, "On the interpretation of a concentration index of inequality", Health Econ, 13(7), pp.649~656 (2004)
- Wagstaff A, "The concentration index of a binary outcome revisited", Health Econ, 20(10), pp.1155~1160 (2011)
- O’Donnell O, "Conindex : estimation of concentration indices", Stata J, 16(1), pp.112~138 (2016)
- 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)
- 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)
- Si Y, "Catastrophic healthcare expenditure and its inequality for households with hypertension : evidence from the rural areas of Shaanxi Province in China", Int J Equity Health, 16(1), pp.27~ (2017)
- Boing AC, "Socioeconomic inequality in catastrophic health expenditure in Brazil", Rev Saude Publica, 48(4), pp.632~641 (2014)
- Asefzadeh S, "Households encountering with catastrophic health expenditures in Qazvin, Iran", Health Inf Manag, 10(1), pp.1~8 (2013)
- Soofi M, "Measuring the exposure of households to catastrophic healthcare expenditures in Iran in 2001 : the World Health Organization and the World Bank’s approach", Hosp J, 12(2), pp.39~50 (2013)[DOI]
- Su TT, "Catastrophic household expenditure for health care in a low-income society : a study from Nouna District, Burkina Faso", Bull World Health Organ, 84(1), pp.21~27 (2006)
- Wagstaff A, "Can insurance increase financial risk? The curious case of health insurance in China", J Health Econ, 27(4), pp.990~1005 (2008)
