Inequality in household catastrophic health care expenditure in a low-income society of Iran

Zahra Kavosi · Arash Rashidian · A Pourreza · Reza Majdzadeh · Farshad Pourmalek · K Mohammad

203 citations0/0 files storedHealth Policy and Planning

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Abstract

BACKGROUND: We assessed change in household catastrophic health care expenditures (CHE) and inequality in facing such expenditures in south-west Tehran. METHODS: A cluster-sampled survey was conducted in 2003 using the World Health Survey questionnaire. We repeated the survey on the same sample in 2008 (635 and 603 households, respectively). We estimated the proportion of households facing CHE using the 'household's capacity to pay'. We identified the determinants of the household CHE using regression analysis and used the concentration index to measure socio-economic inequality and decompose it into its determinants factors. RESULTS: Findings showed that the proportion of household facing CHE had no significant change in this period (12.6% in 2003 vs 11.8% in 2008). The key determinants of CHE for both years were health care utilization and health care insurance status. Socio-economic status was the main contributor to inequality in CHE, while unequal utilization of dentistry and outpatient services had reduced the inequality in CHE between socio-economic groups. CONCLUSIONS: We observed no significant change in the CHE proportion despite policy interventions aimed at reducing such expenditures. Any solution to the problem of CHE should include interventions aimed at the determinants of CHE. It is essential to increase the depth of social insurance coverage by expanding the basic benefit package and reducing co-payments.

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References

2005Social determinants of health inequalities 2001World development report 2000/2001 : attacking poverty 2003Household catastrophic health expenditure: a multicountry analysis 2005Social determinants of health inequalities 2007Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation 2003Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998 2007Protecting Households From Catastrophic Health Spending 2002On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam

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