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

Hajizadeh, Mohammad & 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), pp. 267-285.

View at publisher


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.

Impact and interest:

16 citations in Scopus
Search Google Scholar™
13 citations in Web of Science®

Citation counts are sourced monthly from Scopus and Web of Science® citation databases.

These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.

Citations counts from the Google Scholar™ indexing service can be viewed at the linked Google Scholar™ search.

ID Code: 82234
Item Type: Journal Article
Refereed: Yes
Keywords: Out-of-pocket expenditures, Catastrophic expenditures, Heckman selection model, Hospital care, Iran, D63, H51, I18
DOI: 10.1007/s10754-011-9099-1
ISSN: 1573-6962
Subjects: Australian and New Zealand Standard Research Classification > ECONOMICS (140000) > APPLIED ECONOMICS (140200) > Health Economics (140208)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Deposited On: 05 Mar 2015 22:42
Last Modified: 11 Mar 2015 04:15

Export: EndNote | Dublin Core | BibTeX

Repository Staff Only: item control page