Abstract
The present study aimed to investigate the households' impoverishment due to the healthcare costs in Shiraz in 2012. In this household's survey, 800 households were studied in Shiraz. The study sample was selected using stratified and cluster sampling in the urban and rural areas, respectively. The information was collected using the household section of the World Health Survey questionnaire. In order to determine impoverishment due to health spending, at first, the households' food-based poverty line (subsistence expenditure) was measured. Then, households' health expenditure was subtracted from their total expenditure and if the obtained value was lower than the households' food-based poverty line, the households was considered to be impoverished due to health expenditures. The collected data were entered into the SPSS (version 16) statistical software and analyzed using descriptive statistic, Chi-square test, and logistic regression in backward method. The study results showed that 7.1% of the households (CI: 0.071 ± 0.018) were impoverished because of healthcare expenditures. Besides, the households in the first quintile were more likely to be faced with poverty compared to those in the other quintiles (p < 0.05). Being covered by health insurance did not affect the protection from poverty due to health costs. Moreover, the participants living in rural areas were faced with poverty more than those living in urban areas (p < 0.05). It seems that health expenditure can be an economic shock for household in Shiraz and through spending on health a household may fall into poverty. As insurance had no effect on impoverishment, it implies that change in health insurance plans and ways of health financing is necessary.
Highlights
Health is profoundly influenced by the factors outside the traditional realm of healthcare and poverty is one of the most important ones.[1]
Emphasis on the impoverishing effect of health expenditures takes its origin from the World Health Organization's (WHO) announcement of equitable contribution for financing of health costs as one of the three goals of the health systems.[4]
According to national health accounts, Out Of Pocket (OOP) payment by households is the main source of healthcare financing in Iran (52-60%); such a way that OOP expenditure has soared from 46% to 52% of the total health expenditures from 1995 to 2007.8 This is one of the major problems of health financing in Iran
Summary
Health is profoundly influenced by the factors outside the traditional realm of healthcare and poverty is one of the most important ones.[1]. The economic burden of health services on households is measured using Catastrophic Health Expenditures (CHE) and impoverishment health spending.[5] Catastrophic spending is a household's expenditure which is above a threshold percentage, while impoverishing spending pushes a household below the poverty line This 'medical impoverishment' causes the households to be faced with very tough choices: either forgoing using healthcare services or using them and dropping the family into the poverty trap (voice of the poor).[6,7] According to national health accounts, Out Of Pocket (OOP) payment by households is the main source of healthcare financing in Iran (52-60%); such a way that OOP expenditure has soared from 46% to 52% of the total health expenditures from 1995 to 2007.8 This is one of the major problems of health financing in Iran. 2.5% and 2.8% of Iranian households were faced with catastrophic expenditures in 200710 and 2012,11 respectively
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