Abstract
BackgroundEnsuring financial protection of the community against health care expenditures is one of the fundamental goals of the health system. Catastrophic health expenditures (CHE) occurs when out-of-pocket health expenditures due to health care expenses considerably affect family life. The main purpose of this study was to analyze CHE trend over time and to determine its determinants.MethodsThe last round of a three part study over time was conducted in June to September 2015 on 600 households in a non-affluent area of Tehran. The World Health Survey questionnaire was used to collect information. Health expenditure was considered to be catastrophic when OOP health expenditures exceed 40% of household’s capacity to paysubsistence expenditures. After calculating the amount of households’ exposure to CHE, determinants resulting in CHE using logistic regression and the amount of economic inequality in the exposure of households to CHE using the concentration index were calculated. Then, performing a decomposition analysis, the contribution of each of the studied variables to the observed economic inequality was determined. All the findings were compared with the results of studies carried out in the years 2003 and 2008.ResultsIn the year 2015, 29.9% of households incurred CHE. This amount was 12.6 and 11.8% in the 2003 and 2008 studies, respectively. The concentration index was - 0.017(confidence interval; − 0.086 to 0.051), which, unlike the CI calculated in the years 2003 and 2008, was not significant. The most important determinant affecting the exposure to CHE was inpatient service utilization (OR = 1.64).ConclusionComparing to the whole national wide findings in sum, in 2015, the amount of the exposure of the studied households to CHE was significant, and it in comparison with the results of the previous studies was increased. However, there was no significant economic inequality and the observed levels of inequalityin comparison with the results of the previous studies conducted in 2003 and 2008 were decreased.
Highlights
Ensuring financial protection of the community against health care expenditures is one of the fundamental goals of the health system
In the study carried out in 2008, the same households were re-examined, and in 2015 we looked at the same households and compared the changes [11] and households that could not be included in the study for any reason were replaced with neighboring households
In 2015, 9.8% of households fell below the poverty line due to health expenditures; this amount was decreased compared to the results of the 2003 study, and increased compared tothe results of the 2008 study (Table 2)
Summary
Ensuring financial protection of the community against health care expenditures is one of the fundamental goals of the health system. According to the World Health Organization, health expenditure is considered to be catastrophic when OOP health expenditures exceed 40% (in some studies, 10, 20, 25%, or 40% of total expenditure) of household’s capacity to paysubsistence expenditures (i.e., available income after fixing basic needs) [21, 34, 36, 37]. This happens more often in lowincome and middle-income countries, where most of their health costs are paid out of their pockets. In another study based on Statistical Center of Iran (SCI) Surveydata, the exposure rate to CHE in rural and urban households in 2015 to 2016 estimated 5.65 and 4.58%, respectively [17]
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