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

Hajizadeh, Mohammad and Nghiem, Hong Son (2011) Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?. International Journal of Health Care Finance and Economics, 11 4: 267-285. doi:10.1007/s10754-011-9099-1

Author Hajizadeh, Mohammad
Nghiem, Hong Son
Title Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?
Journal name International Journal of Health Care Finance and Economics   Check publisher's open access policy
ISSN 1389-6563
Publication date 2011-11-01
Sub-type Article (original research)
DOI 10.1007/s10754-011-9099-1
Open Access Status Not yet assessed
Volume 11
Issue 4
Start page 267
End page 285
Total pages 19
Place of publication New York, United States
Publisher Springer
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.
Keyword Catastrophic expenditures
Heckman selection model
Hospital care
Out-of-pocket expenditures
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Economics Publications
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 21 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 25 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Thu, 28 Nov 2013, 09:58:13 EST by System User on behalf of School of Economics