Abstract
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. 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. 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. 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.
Highlights
As announced in the constitution of World Health Organization (WHO), the enjoyment of the highest attainable standard of health requires taking steps in order to achieve universal coverage
23.97 of health system reform in May, 2014. These expenditures are still high; compared with similar studies conducted using identical method in different parts of Iran prior to the implementation of health system reform plan, the results of our study showed the rate of households facing catastrophic health expenditures (CHE) to be lower, and this rate has decreased twofold or even more.[7,19]
Considering the relevant studies conducted using similar method in different provinces of Iran[7,19] prior to the implementation of the health sector evolution plan (HSEP) and comparing their results with those obtained in our study, it is concluded that despite the high rate of the CHE (4.8%) and not achieving the objective emphasized in the Fifth Economic, Social, and Cultural Development Plan,[21] it appears that the occurrence of CHE has declined at the household level after the implementation of HSEP
Summary
As announced in the constitution of World Health Organization (WHO), the enjoyment of the highest attainable standard of health requires taking steps in order to achieve universal coverage. To achieve this goal, countries need a type of financial system which enables people to utilize health services without any financial barrier. One of the fundamental actions taken in order to reduce financial barriers of using. Full list of authors’ affiliations is available at the end of the article. Direct payment is the most unfair and most inefficient way to financing health system and can lead to catastrophic payment.[2,3] The WHO recognizes households facing catastrophic health expenditures (CHE) when the household out-of-pocket (OOP) expenditure on health is equal to or higher than 40% of the households’ capacity to pay.[4,5,6] The
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