1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
3Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
Background One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE.
Methods A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model.
Results The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services.
Conclusion The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.
Delavari H, Keshtkaran A, Setoudehzadeh F. Catastrophic health expenditures and coping strategies in households with cancer patients in shiraz namazi hospital. Middle East Journal of Cancer. 2014;5(1):13-22.
Knaul FM, Arreola-Ornelas H, Méndez-Carniado O, et al. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. Lancet. 2006;368(9549):1828-1841. doi:10.1016/s0140-6736(06)69565-2
Kavosi Z, Rashidian A, Pourreza A, et al. Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan. 2012;27(7):613-623. doi:10.1093/heapol/czs001
Hajizadeh M, Nghiem HS. Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments? Int J Health Care Finance Econ. 2011;11(4):267-285. doi:10.1007/s10754-011-9099-1
Abul Naga RH, Lamiraud K. Catastrophic health expenditure and household well-being. Working Paper; 2011.
Van Doorslaer E, O'Donnell O, Rannan-Eliya RP, et al. Catastrophic payments for health care in Asia. Health Econ. 2007;16(11):1159-1184. doi:10.1002/hec.1209
Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff. 2007;26(4):972-983. doi:10.1377/hlthaff.26.4.972
Murray CJ, Knaul F, Musgrove P, Xu K, Kawabata K. Defining and measuring fairness in financial contribution to the health system. Geneva: World Health Organization; 2001.
Roberts M, Hsiao W, Berman P, Reich M. Getting health reform right: a guide to improving performance and equity. Oxford university press; 2008.
Shadpour K. Health sector reform in Islamic Republic of Iran. Hakim Research Journal. 2006;9(3):1-18.
Statistical Centre of Iran. Iran National Health Accounts, 2002-2008. Accessed August 21, 2015. Published 2011.
World Health Organization (WHO). The Work of WHO in the Eastern Mediterranean Region. Geneva: World Health Organization; 2011.
Rashidian A, Karimi-Shahanjarini A, Khosravi A, et al. Iran's Multiple Indicator Demographic and Health Survey-2010: Study Protocol. Int J Prev Med. 2014;5(5):632.
Amery H, Jafari A, Panahi M. Determining the rate of catastrophic health expenditure and its influential factors on families in Yazd province. J Health Adm. 2013;16(52):51-60.
Kavosi Z, Keshtkaran A, Hayati R, Ravangard R, Khammarnia M. Household financial contribution to the health System in Shiraz, Iran in 2012. Int J Health Policy Manag. 2014;3(5):243. doi:10.15171/ijhpm.2014.87
Karami M, Najafi F, Karami Matin B. Catastrophic health expenditures in Kermanshah, west of Iran: magnitude and distribution. J Res Health Sci. 2009;9(2):36-40.
Planning and Management Organization of the Islamic Republic of Iran. Five-Year Economic, Social and Cultural Development Plan of the Islamic Republic of Iran, 2010-2015. Tehran: Deputy for Research, Development and Codification of Laws and Regulations; 2009.
Moradi-Lakeh M, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns. Int J Health Policy Manag. 2015;4(10):637-640. doi:10.15171/ijhpm.2015.160
Li Y, Wu Q, Xu L, et al. Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. Bull World Health Organ. 2012;90(9):664-671. doi:10.2471/blt.12.102178
Abolhallaje M, Hasani S, Bastani P, Ramezanian M, Kazemian M. Determinants of catastrophic health expenditure in iran. Iran J Public Health. 2013;42(Supple1):155.
Piroozi B, Rashidian A, Moradi Gh, Takian A. Assessing the impact of health system reform of the Islamic Republic of Iran: A Case Study in Kurdistan Province. Tehran: Health Care Management Department, Tehran University of Medical Sciences; 2016.
Somkotra T, Lagrada LP. Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage. Health Aff. 2009;28(3):w467-w478. doi:10.1377/hlthaff.28.3.w467
Yardim MS, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy. 2010;94(1):26-33. doi:10.1016/j.healthpol.2009.08.006
Waters HR, Anderson GF, Mays J. Measuring financial protection in health in the United States. Health policy. 2004;69(3):339-349.
Su TT, Kouyaté B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bull World Health Organ. 2006;84(1):21-27. doi:10.2471/blt.05.023739
Sun X, Jackson S, Carmichael G, Sleigh AC. Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ. 2009;18(1):103-119. doi:10.1002/hec.1346