Socioeconomic status and catastrophic health expenditure evaluation in IR Iran: A comparative study in 2004 and 2011
Social Determinants of Health,
Vol. 1 No. 2 (2015),
23 December 2015
,
Page 48-59
https://doi.org/10.22037/sdh.v1i2.9288
Abstract
Background: Health equity is a main principle of all healthcare systems in the world. Family Physician (FP) program, as a health sector reform (HSR) in Iran, was executed to reduce households’ health care cost and to achieve health equity in 2004. Meanwhile, catastrophic health expenditure is known as an accepted indicator in HSR evaluation. In this context, after determining and comparing socioeconomic status (SES) among different periods, we made an attempt to evaluate households’ health financial protection in different quintiles after implementation of FP program.
Methods: The current cross-sectional study was based on the data obtained from Household Income and Expenditure Survey in 2004 and 2011. The health expenditures, catastrophic health expenditure (CHE), and SES were determined by this data during these years. Descriptive analyses and comparisons using Chi-squared test were carried out via SPSS, version 20.
Results: A total of 1716 households were included in the survey during 2004 and 2011. The highest proportion of households was related to quintiles very poor and poor with respect to each year. Moreover, it was observed that SES in 2011 had the worse situation compared to that in 2004; this situation was worse in urban areas. In the present study, CHE is related to poorer quintiles, and in rural areas no household was faced with CHE in 2011.
Conclusions: Implementation of FP program in rural areas with more primary care has prevented hospitalization. This was considerable for poorer quintiles and has led to financial protection for rural households.
- Health Care costs
- Health Equity
- Primary Health Care
- Social Class
How to Cite
References
Yardim MS, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy. 2010;94(1):26-33.
Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics. 2009 Winter;20(4):330-42. PubMed PMID: 20120853. Pubmed Central PMCID: 3612701. Epub 2010/02/04. eng.
Devadasan N, Criel B, Van Damme W, Ranson K, Van der Stuyft P. Indian community health insurance schemes provide partial protection against catastrophic health expenditure. BMC Health Services Research. 2007;7(1):43.
Limwattananon S, Tangcharoensathien V, Prakongsai P. Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bulletin of the World Health Organization. 2007;85(8):600-6.
Kruk ME, Goldmann E, Galea S. Borrowing and selling to pay for health care in low-and middle-income countries. Health Affairs. 2009;28(4):1056-66.
Schieber GJ, Gottret P, Fleisher LK, Leive AA. Financing global health: mission unaccomplished. Health Affairs. 2007;26(4):921-34.
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. The Lancet. 2003;362(9378):111-7.
P. M. Public spending on health care: how are different criteria related? health policy. 2000;53:61-7.
Merlis, M. Family out-of-pocket spending for health services: a continuing source of financial insecurity. 2003. (New York: Commonwealth Fund, June 2002).
Oakes JM, Rossi PH. The measurement of SES in health research: current practice and steps toward a new approach. Social science & medicine. 2003;56(4):769-84.
Regidor E, Martínez D, Calle ME, Astasio P, Ortega P, Domínguez V. Socioeconomic patterns in the use of public and private health services and equity in health care. BMC Health Services Research. 2008;8(1):183.
Galobardes B, Lynch J, Smith GD. Measuring socioeconomic position in health research. British Medical Bulletin. 2007;81(1):21-37.
Braveman PA. Monitoring equity in health and healthcare: a conceptual framework. Journal of Health, Population and Nutrition (JHPN). 2011;21(3):181-92.
Waning B, et al. Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan. . International Journal for Equity in Health. 2009 (8).
Majdzadeh R. Family physician implementation and preventive medicine; opportunities and challenges. International journal of preventive medicine. 2012;3(10):665.
Moghadam M, Javar M. Iranian Household Financial Protection against Catastrophic Health Care Expenditures. Iranian Journal of Public Health. 2012;41(9).
Three Decades of Endeavor on the Healthcare Front.Status Report on Health Care and Medical Education in Iran.Tehran:Ministry of Health & Medical Education. 2009.
Takian A, Rashidian A, Kabir MJ. Expediency and coincidence in re-engineering a health system: an interpretive approach to formation of family medicine in Iran. Health policy and planning. 2011;26(2):163-73.
Khadivi R, Kheyri M. Does family physician programme in iran improve financial contribution of patients. International journal of current life sciences. 2014;4(8):4383-7.
Roy K, Howard DH. Equity in out-of-pocket payments for hospital care: evidence from India. Health Policy. 2007;80(2):297-307.
Organization WH, editor Equity in access to public health. Report and Documentation of the Technical Discussion held in conjunction with 37th Meeting of CCPDM, Regional Office for South-East Asia, New Delhi; 2000.
Son HH. Equity in Health and Health Care in the Philippines. Asian Development Bank Economics Working Paper Series. 2009 (171).
Carlyle C. "the participation of associate member countries in united nations world conferences." (2004).
Eggermont J, van Hemert J, editors. Stepwise adaptation of weights for symbolic regression with genetic programming. Proceedings of the Twelveth Belgium/Netherlands Conference on Artificial Intelligence (BNAIC’00); 2000: KUB, De Efteling, Kaatsheuvel, Holland.
Somkotra T, Lagrada LP. Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage. Health Affairs. 2009;28(3):w467-w78.
Karami M NF, Karami Matin B. Catastrophic health expenditures in Kermanshah, west of Iran:magnitude and distribution. Journal of research in health sciences;9(2):36-40. 2009.
Kavosi Z , Pourmalek F, Majdzadeh R,Pourreza A, Mohammad K, et al. Measuring household exposure to catastrophic health care expenditures: a Longitudinal study in Zone 17 of Tehran. . Hakim Research Journal;12(2):38-47. 2009.
Knaul FM, Wong R, Arreola-Ornelas H, Méndez O. Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries. Salud Publica Mex. 2011;53.
Sesma-Vázquez S, Perez-Rico R, Sosa-Manzano C, Gomez-Dantes O. [Catastrophic health expenditures in Mexico: magnitude, distribution and determinants]. Salud publica de Mexico. 2004;47:S37-46.
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