International Journal of Health Policy and Management

International Journal of Health Policy and Management

Household Financial Contribution to the Health System in Shiraz, Iran in 2012

Document Type : Original Article

Authors
Zahra Kavosi 1
Ali Keshtkaran 1
Ramin Hayati 2
Ramin Ravangard 1
Mohammad Khammarnia 2
1 Department of Health Services Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
10.15171/ijhpm.2014.87
Abstract
Background
One common challenge to social systems is achieving equity in financial contributions and preventing financial loss. Because of the large and unpredictable nature of some costs, achieving this goal in the health system presents important and unique problems. The present study investigated the Household Financial Contributions (HFCs) to the health system.
 
Methods
The study investigated 800 households in Shiraz. The study sample size was selected using stratified sampling and cluster sampling in the urban and rural regions, respectively. The data was collected using the household section of the World Health Survey (WHS) questionnaire. Catastrophic health expenditures were calculated based on the ability of the household to pay and the reasons for the catastrophic health expenditures by a household were specified using logistic regression.
 
Results
The results showed that the fairness financial contribution index was 0.6 and that 14.2% of households were faced with catastrophic health expenditures. Logistic regression analysis revealed that household economic status, the basic and supplementary insurance status of the head of the household, existence of individuals in the household who require chronic medical care, use of dental and hospital care, rural location of residences, frequency of use of outpatient services, and Out-of-Pocket (OOP) payment for physician visits were effective factors for determining the likelihood of experiencing catastrophic health expenditure.
 
Conclusion
It appears that the current method of health financing in Iran does not adequately protect households against catastrophic health expenditure. Consequently, it is essential to reform healthcare financing.
Keywords
Household Financial Contribution (HFC)
Health System
Catastrophic Health Expenditure
Fair Financial Contribution Index (FFCI)
Subjects
  1. 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.
  2. Pal R. Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India. Int J Health Care Finance Econ 2012; 12: 63-85.   doi: 10.1007/s10754-012-9103-4
  3. Murray CJ, Evans D. Health systems performance assessment: debates, methods and empiricism. Geneva: World Health Organization; 2006.
  4. Murray CJ, Xu K, Klavus J, Kawabata K, Hanvoravongchai P, Zeramdini R, et al. Assessing the distribution of household financial contributions to the health system: concepts and empirical application. Health systems performance assessment: debates, methods and empiricism. Geneva: World Health Organization;2003. 
  5. van Doorslaer E, O’Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, et al. Catastrophic payments for health care in Asia. Health Econ 2007; 16: 1159-84.   doi: 10.1002/hec.1209
  6. World Health Organization (WHO). Designing health financing systems to reduce catastrophic health expenditure. Geneva: World Health Organization; 2005. 
  7. Merlis M, Gould D, Mahato B, Fund C. Rising out-of-pocket spending for medical care: a growing strain on family budgets [Internet]. Commonwealth Fund 2006.  Available from:  http://www.commonwealthfund.org/publications/fund-reports/2006/feb/rising-out-of-pocket-spending-for-medical-care--a-growing-strain-on-family-budgets
  8. Knaul FM, Arreola-Ornelas H, Méndez-Carniado O, Bryson-Cahn C, Barofsky J, Maguire R, et al. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. Lancet 2006; 368: 1828-41. doi: 10.1016/s0140-6736(06)69565-2
  9. Limwattananon S, Tangcharoensathien V, Prakongsai P. Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bull World Health Organ 2007; 85: 600-6. doi: 10.2471/blt.06.033720
  10. Adhikari SR, Maskay NM, Sharma BP. Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences. Health Policy Plan 2009; 24: 129-39. doi: 10.1093/heapol/czn052
  11. 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: 21-7.   doi: 10.2471/blt.05.023739
  12. Somkotra T, Lagrada LP. Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage. Health Aff (Millwood) 2009; 28: w467-78. 
  13. Wyszewianski L. Families with catastrophic health care expenditures. Health Serv Res 1986; 21: 617. 
  14. Basar D, Brown S, Hole AR. Out-of-pocket health care expenditure in Turkey: analysis of the household budget surveys 2002-2008 [internet]. 2012.   Available from: http://www.sheffield.ac.uk/economics/research/serps/articles/2012_020
  15. 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: 103-19.  doi: 10.1002/hec.1346
  16. Daneshkohan A, Karami M, Najafi F, Matin BK. Household catastrophic health expenditure. Iran J Public Health 2011; 40: 94. 
  17. Razavi S, Hassanzadeh A, Basmenji K. [Fairness in financial contribution in the health system]. Tehran: Andishmand publication; 2005. 
  18. Daniel WW, Cross CL. Biostatistics: A Foundation for Analysis in the Health Sciences: A Foundation for Analysis in the Health Sciences. Hoboken, NJ: Wiley; 2012.
  19. Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F, Hosseinpour AR, et al. Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan 2012; 27: 613-23. doi: 10.1093/heapol/czs001
  20. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003; 362: 111-7. doi: 10.1016/s0140-6736(03)13861-5
  21. Hjortsberg C. Why do the sick not utilise health care? The case of Zambia. Health Econ 2003; 12: 755-70.   doi: 10.1002/hec.839
  22. Wagstaff A, Doorslaer EV. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Economics 2003; 12: 921-33. doi: 10.1002/hec.776
  23. Mehrara M, Fazaeli A. [Health finance equity in Iran: an analysis of household survey data (2003-2007)]. Journal of health administration 2010; 13: 51-62. 
  24. Kavosi Z, Rashidian A, Pourmalek F, Majdzadeh R, Pourreza A, Mohammad K, et al. Measuring household exposure to catastrophic health care expenditures: a Longitudinal study in Zone 17 of Tehran. Hakim Research Journal 2009; 12: 38-47. 
  25. Knaul FM, Wong R, Arreola-Ornelas H, Méndez O, Bitran R, Campino AC, et al. Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries. Salud Publica Mex 2011; 53: s85-95. 
  26. Yardim MS, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy 2010; 94: 26-33. doi: 10.1016/j.healthpol.2009.08.006
  27. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff (Millwood) 2007; 26: 972-83.   doi: 10.1377/hlthaff.26.4.972
  28. Kwon S. Health care financing in Asia: key issues and challenges. Asia Pac J Public Health 2011; 23: 651-61. doi: 10.1177/1010539511422940
  29. O’donnell O, van Doorslaer E, Rannan-Eliya RP, Somanathan A, Adhikari SR, Akkazieva B, et al. Who pays for health care in Asia? J Health Econ 2008; 27: 460-75. doi: 10.1016/j.jhealeco.2007.08.005
  30. Mishra SK, Mukhopadhyay S. Socioeconomic correlates of reproductive morbidity among adolescent girls in Sikkim, India. Asia Pac J Public Health 2012; 24: 136-50. doi: 10.1177/1010539510375842
  31. Ghiasvand H, Hadian M, Maleki M, Shabaninejad H. Determinants of Catastrophic Medical Payments in Hospitals Affiliated to Iran University of Medical Sciences; 2009. Hakim Research Journal 2010; 13: 145-54. 
  32. Mohammad-Alizade Hanji  H,  Fazaeli  A A. Equity of health care financing in Iran. Social Welfare Quarterly 2005; 19: 279-300.

 

  • Received Date 23 April 2014
  • Revised Date 17 September 2014
  • Accepted Date 14 September 2014
  • First Published Date 01 October 2014
  • Published Date 01 October 2014