Skip to main content

Advertisement

SpringerLink
Log in

Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?

  • Published:
International Journal of Health Care Finance and Economics Aims and scope Submit manuscript

Abstract

Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian—regardless of their employment status—can better protect households from catastrophic health spending.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Amaya Lara J., Ruiz Gomez F. (2011) Determining factors of catastrophic health spending in Bogota, Colombia. International Journal of Health Care Finance and Economics 11(2): 83–100

    Article  PubMed  Google Scholar 

  • Asadi-Lari M., Sayyari A., Akbari M., Gray D. (2004) Public health improvement in Iran: Lessons from the last 20 years. Public Health 118(6): 395–402

    Article  PubMed  CAS  Google Scholar 

  • Berman P. (1995) Health sector reform: Making health development sustainable. Health Policy 32(1–3): 13–28

    Article  PubMed  CAS  Google Scholar 

  • Castano-Yepes R. A., Arbelaez J. J., Giedion U. B., Morales L. G. (2002) Equitable financing, out-of-pocket payments and the role of health care reform in Colombia. Health Policy and Planning 17: 5–11

    Article  Google Scholar 

  • Greene W. H. (2003) Econometrics analysis. Prentice Hall, Upper Saddle River, NJ

    Google Scholar 

  • Habibov N. (2010) Hospitalisation in Tajikistan: Determinants of admission, length of stay, and out-of-pocket expenditures. Results of a national survey. International Journal of Health Planning Management 25: 251–269

    Google Scholar 

  • Hajizadeh M., Connelly L. B. (2010) Equity of health care financing in Iran: The effect of extending health insurance to the uninsured. Oxford Development Studies 38(4): 461–476

    Article  Google Scholar 

  • Holahan J., Zedlewski S. (1992) Who pays for health care in the United States? Implications for health system reform. Inquiry 29: 231–248

    PubMed  CAS  Google Scholar 

  • Hosseinpoor A. R., Naghavi M., Alavian S. M., Speybroeck N., Jamshidi H., Vega J. (2007) Determinants of seeking needed outpatient care in Iran: Results from a national health services utilisation survey. Archive of Iranian Medicine 10(4): 439–445

    Google Scholar 

  • Janssen R., van Doorslaer E., Wagstaff A. (1994) Health insurance reform in the Netherlands: Assessing the progressivity consequences. Economic and Social Review 25: 302–320

    Google Scholar 

  • Kakwani N., Wagstaff A., van Doorslaer E. (1997) Socioeconomic inequalities in health: Measurement, computation, and statistical inference. Journal of Econometrics 77(1): 87–103

    Article  Google Scholar 

  • Lairson D. R., Hindson P., Hauquitz A. (1995) Equity of health care in Australia. Social Science and Medicine 41(4): 475–482

    Article  PubMed  CAS  Google Scholar 

  • Limwattananon S., Tangcharoensathien V., Prakongsai P. (2007) Catastrophic and poverty impacts of health payments: Results from national household surveys in Thailand. Bulletin of the World Health Organisation 85: 600–606

    Article  Google Scholar 

  • Londono J., Frenk J. (1997) Structured pluralism: Towards an innovative model for health system reform in Latin America. Health Policy 41(1): 1–36

    Article  PubMed  CAS  Google Scholar 

  • Management and Planning Organisation. (2005). Iran’s fourth socio-economic development act: Government of Iran. Tehran: Management and Planning Organisation

  • Mehrdad R. (2009) Health system in Iran. Japan Medical Association Journal 52(1): 69–73

    Google Scholar 

  • Natawa K. (1993) A note on the estimation of models with sample selection biases. Economic Letters 42: 15–24

    Article  Google Scholar 

  • O’Donnell O., van Doorslaer E., Wagstaff A., Lindelow M. (2007) Analysing health equity using household survey data—A guide to techniques and their implementation. The World Bank, Geneva

    Book  Google Scholar 

  • O’Donnell O., van Doorslaer E., Rannan-Eliya R. P., Somanathan A., Adhikari S. R., Akkazieva S. R. B. et al (2008) Who pays for health care in Asia?. Journal of Health Economics 27(2): 460–475

    PubMed  Google Scholar 

  • Okunade A. A., Suraratdecha C., Benson D. A. (2010) Determinants of Thailand household healthcare expenditure: The relevance of permanent resources and other correlates. Health Economics 19: 365–376

    Article  PubMed  Google Scholar 

  • Roodman, D. (2009). Mixed-process models with cmp. Technical Report 11, Center for Global Development.

  • Sesma-Vazquez S., Perez-Rico R., Sosa-Manzano C. L., Gomez-Dantes O. (2005) Catastrophic health expenditures in Mexico: Magnitude, distribution and determinants. Salud Publica de Mexico 47: S37–S46

    PubMed  Google Scholar 

  • Shen Y. C., McFeeters J. (2006) Out-of-pocket health spending between low-and higher-income populations: who is at risk of having high expenses and high burdens?. Medical Care 44: 200–209

    Article  PubMed  Google Scholar 

  • Smith S. (2010) Equity in Irish health care financing: Measurement issues. Health Economics, Policy Law 5(April): 149–169

    Article  Google Scholar 

  • Somkotra T., Lagrada L. P. (2008) Payments for health care and its effect on catastrophe and impoverishment: Experience from the transition to Universal Coverage in Thailand. Social Science and Medicine 67: 2027–2035

    Article  PubMed  Google Scholar 

  • Sun X., Jackson S., Carmichael G., Sleigh A. C. (2009) Catastrophic medical payment and financial protection in rural China: Evidence from the New Cooperative Medical Scheme in Shandong Province. Health Economics 18: 103–119

    Article  PubMed  Google Scholar 

  • Van Doorslaer E., O’Donnell O., Rannan-Eliya R. P., Somanathan A., Adhikari S. R., Garg C. C. et al (2007) Catastrophic payments for health care in Asia. Health Economics 16: 1159–1184

    Article  PubMed  Google Scholar 

  • Vyas S., Kumaranayake L. (2006) Constructing socio-economic status indices: How to use principal components analysis. Health Policy and Planning 21(6): 459–468

    Article  PubMed  Google Scholar 

  • Wagstaff A., van Doorslaer E., Calonge S., Christiansen T., Gerfin M., Gottschalk P. et al (1992) Equity in the finance of health care: Some international comparisons. Journal of Health Economics 11(4): 361–387

    Article  PubMed  CAS  Google Scholar 

  • Wagstaff A., van Doorslaer E., VanDer Burg H., Calonge S., Christiansen T., Citoni G. et al (1999) Equity in the finance of health care: Some further international comparisons. Journal of Health Economics 18(3): 263–290

    Article  PubMed  CAS  Google Scholar 

  • Wagstaff A., van Doorslaer E. (2003) Catastrophe and impoverishment in paying for health care: With applications to Vietnam 1993–1998. Health Economics 12: 921–934

    Article  PubMed  Google Scholar 

  • Waters H. R., Anderson G. F., Mays J. (2004) Measuring financial protection in health in the United States. Health Policy 69: 339–349

    Article  PubMed  Google Scholar 

  • World Bank. (2010). Iran National Health Accounts. http://www.who.int/nha/docs/en/Iran_NHA_report_english.pdf. Accessed 20 March 2010.

  • World Health Organisation. (2000). The World Health Report 2000: health systems: improving performance. World Health Organisation, Geneva, Switzerland

  • World Health Organisation. (2010). National Health Accounts. Geneva, Switzerland. http://www.who.int/whosis/en. Accessed 26 July 2010.

  • Xu K., Evans D. B., Kawabata K., Zeramdini R., Klavus J., Murray C. J. L. (2003) Household catastrophic health expenditure: A multicounty analysis. Lancet 362: 111–117

    Article  PubMed  Google Scholar 

  • Yardim M. S., Cilingiroglu N., Yardim N. (2010) Catastrophic health expenditure and impoverishment in Turkey. Health Policy 94: 26–33

    Article  PubMed  Google Scholar 

  • Yi Y., Maynard A., Liu G., Xiong X., Lin F. (2005) Equity in health care financing: Evaluation of the current Urban Employee Health Insurance reform in China. Journal of the Asia Pacific Economy 10: 506–527

    Article  Google Scholar 

  • Yu C. P., Whynes D. K., Sach T. (2006) Assessing progressivity of out-of-pocket payments: With illustration to Malaysia. International Journal for Health Planning and Management 21: 193–210

    Article  Google Scholar 

  • Yu C. P., Whynes D. K., Sach T. (2008) Equity in health care financing: The case of Malaysia. International Journal for Equity in Health 7: 15

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Australian Centre for Economic Research on Health (ACERH) and School of Economics, The University of Queensland, Ground Floor, Edith Cavell Building, Royal Brisbane and Women’s Hospital, Herston, QLD, 4029, Australia

    Mohammad Hajizadeh

  2. Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Brisbane, QLD, Australia

    Hong Son Nghiem

Authors
  1. Mohammad Hajizadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong Son Nghiem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammad Hajizadeh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hajizadeh, M., Nghiem, H.S. Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?. Int J Health Care Finance Econ 11, 267–285 (2011). https://doi.org/10.1007/s10754-011-9099-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10754-011-9099-1

Keywords

JEL Classification

Search

Navigation