Household catastrophic health expenditure and its effective factors: a case of Iran

Ramin Ravangard,Abdosaleh Jafari,Peivand Bastani,Faride Sadat Jalali,Mohsen Bayati,Andrew J. Palmer

doi:10.1186/s12962-021-00315-2

Abstract

BackgroundThe World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018.MethodsThe present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the “WHO Global Health Survey” questionnaire. CHEs were defined as health expenditures exceeding 40% of households’ capacity to pay. Households living below the poverty line before paying for health services were excluded from the study. The associations between the households’ characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modeling in SPSS 23.0 at the significance level of 5%.ResultsThe results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR = 3.14, P-value < 0.001), households with disabled members (OR = 27.98, P-value < 0.001), households with children under 5 years old (OR = 2.718, P-value = 0.02), and those without supplementary health insurance coverage (OR = 1.87, P-value = 0.01).ConclusionCHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

Highlights

The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures
The results of Chi-Square test showed that facing catastrophic health expenditures (CHEs) was associated with homeownership (P-value < 0.001), having disabled family members (P-value < 0.001), and having supplementary health insurance coverage (P-value < 0.001), so that out of 431 households living in the rented houses, 22% (93 households) faced CHEs
Multiple logistic regression showed that the probability of facing CHEs in households living in rented houses was Facing catastrophic health expenditures

Summary

Introduction

The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Financial protection means that no household should spend more than a “reasonable proportion” of its income to finance special health services. This ratio, which includes both direct and indirect health expenditures, should not exceed the household’s ability to pay, which is the result of subtracting the minimum subsistence expenditure from the total household expenses over a given period. The catastrophic health expenditure in the first approach is defined as follows: direct out-of-pocket payments for health care that go beyond a certain threshold of income or household expenses. According to the World Health Organization, a household is faced with CHEs when more than 40% of its ability to pay has been spent on healthcare expenditures [10]

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Conclusion