Abstract
Aim
Out-of-pocket payment (OPP) is an indicator of health system financing and health equity. In Iran, OPP and catastrophic health expenditure (CHE) has recently increased. This study aimed to assess the share of OPP and the possibility of CHE in three provinces of Iran: Esfahan, Semnan, and Gilan.
Subject and methods
This was a cross-sectional study conducted in November 2021. Individuals over the age of 18 were selected from the Integrated Health System (SIB) registry of cities with over 20,000 population in the three provinces, regardless of their role in the household, using systematic sampling. Data on participants’ characteristics and OOP were collected via phone interviews. The household’s capacity to pay and CHE were determined.
Results
Of the 569 participants, 66.3% were female, 90.3% were married, and 36.2% were head of household; 86.8% were covered by basic health insurance, and 40.2% by supplementary health insurance; 35% spent less than 10% of their total household expenses on out-of-pocket health payments, and 29% experienced CHE. Provinces of residence, education level, being the head of the household, job status, being hospitalized in the year prior to the study, and age had a significant association with the ratio of the household health expenditure to the total household expenditure and experiencing CHE (p < 0.05).
Conclusion
The results pointed to those characteristics of the population with a possible association with catastrophic expenditures and impoverishment due to OPP. These findings may provide insights into national policies and strategies aimed to achieve health equity.
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Abbreviations
- OPP:
-
Out-of-Pocket Payment
- CHE:
-
Catastrophic Health Expenditure
- WHO:
-
World Health Organization
- SIB:
-
Integrated Health System
- SPSS:
-
Statistical Package for the Social Sciences
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Acknowledgments
The authors thank all participants in this study
Funding
This study was supported by the Deputy of Health, Ministry of Health and Medical Education and the World Health Organization, Iran Office under the grant number 202640666.
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Conceptualization was done by Abtin Heidarzadeh; Material preparation and data collection were performed by Abtin Heidarzadeh, Alireza moravveji, Farshid Farivar, Pouya Naghshpour, Farhad Roshan Fekr; data analysis were performed by Roksana Mirkazemi and Romina Negari. The first draft of the manuscript was written by Roksana Mirkazemi and Romina Negari. All authors read and approved the final manuscript.
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Heidarzadeh, A., Negari Namaghi, R., Moravveji, A. et al. Out-of-pocket and catastrophic health expenditure in Iran. J Public Health (Berl.) 32, 413–419 (2024). https://doi.org/10.1007/s10389-023-01824-5
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DOI: https://doi.org/10.1007/s10389-023-01824-5