Household catastrophic health expenditure and its effective factors: a case of Iran

Abstract Background The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018. Methods The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the “WHO Global Health Survey” questionnaire. CHEs were defined as health expenditures exceeding 40% of households’ capacity to pay. Households living below the poverty line before paying for health services were excluded from the study. The associations between the households’ characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modeling in SPSS 23.0 at the significance level of 5%. Results The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR = 3.14, P-value < 0.001), households with disabled members (OR = 27.98, P-value < 0.001), households with children under 5 years old (OR = 2.718, P-value = 0.02), and those without supplementary health insurance coverage (OR = 1.87, P-value = 0.01). Conclusion CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

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Household Catastrophic Health Expenditure and Its Effective Factors: A Case of Iran

10.21203/rs.3.rs-73105/v1 ◽

2020 ◽

Author(s):

Abdosaleh Jafari ◽

Farideh Sadat Jalali ◽

Mohsen Bayati ◽

Andrew J. Palmer ◽

Peivand Bastani ◽

...

Keyword(s):

Health Insurance ◽

Insurance Coverage ◽

Health Expenditures ◽

Health Care Expenditures ◽

Health Insurance Coverage ◽

World Health ◽

P Value ◽

Cross Sectional ◽

Significance Level ◽

Supplementary Health Insurance

Abstract Background:The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018.Methods:The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the "WHO Global Health Survey” questionnaire. CHEs were defined as health expenditures exceeding 40% of households’ capacity to pay. The associations between the households’ characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modelling in SPSS 23.0 at the significance level of 5%. Results:The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR=3.14, P-value<0.001), households with disabled members (OR=27.98, P-value<0.001), households with children under 5 years old (OR=2.718, P-value=0.02), and those without supplementary health insurance coverage (OR=1.87, P-value=0.01).Conclusion:CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

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Out of pocket expenditure among Rashtriya Swasthya Bima Yojana beneficiary and non-beneficiary patients admitted to a tertiary care centre, Berhampur, India: a comparative study

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20191144 ◽

2019 ◽

Vol 6 (2) ◽

pp. 376

Author(s):

Sushree Priyadarsini Satapathy ◽

Nivedita Karmee ◽

Durga Madhab Satapathy ◽

Radha Madhab Tripathy

Keyword(s):

Health Insurance ◽

Life Support ◽

Insurance Coverage ◽

Tertiary Care ◽

Total Sample ◽

Health Insurance Coverage ◽

P Value ◽

Indian Government ◽

Tertiary Care Centre ◽

Cross Sectional

Background: RSBY, a health insurance scheme, was launched by the Indian government to protect BPL families from incurring financial liabilities which are likely to occur due to hospitalization. Objectives was to compare over all OOPE among RSBY beneficiaries and non-beneficiaries and to estimate its extent during hospitalization in different domains among RSBY beneficiaries and non-beneficiaries.Methods: It was a cross-sectional study conducted for 2 months (January-February 2018) among BPL families residing in Ganjam district, Odisha. Multistage random sampling was done. Total sample size was 256, the number of beneficiaries and non beneficiaries taken was 128 each.Results: Non beneficiaries incurred higher overall OOPE higher i.e. 95.3% than the Beneficiaries and it was found to be statistically significant with x²=74.8 and P-value <0.001. Among beneficiaries out of pocket expenditure was found in 46.1% of the study population. 45.3% of beneficiaries had to borrow partially from friends and relatives to fulfil their hospital related expenses followed by 32% borrowing fully for their treatment. Among beneficiaries, most out of pocket expenditure was for life support services as they sought treatment mostly for surgical conditions.Conclusions: Health insurance coverage should be improved by increasing enrolment. People should be made aware about the services covered under the schemes.

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PARTICIPATING IN HEALTH INSURANCE AND FACTORS AFFECTING AMONG PERSONS WHOSE ENROLMENT IS VOLUNTARY IN THUA THIEN HUE PROVINCE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.4_5.12 ◽

2015 ◽

pp. 89-95

Author(s):

Thi Hoai Thuong Nguyen ◽

Hoang Lan Nguyen ◽

Mau Duyen Nguyen

Keyword(s):

Health Insurance ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Health Insurance Scheme ◽

Insurance Scheme ◽

Cross Sectional ◽

Factors Affecting ◽

The People ◽

Universal Health Insurance Coverage ◽

The Social

Background:To provide information helps building policy that meets the practical situation and needs of the people with the aim at achieving the goal of universal health insurance coverage, we conducted this study with two objectives (1) To determine the rate of participating health insurance among persons whose enrolment is voluntary in some districts of ThuaThien Hue province; (2) To investigate factor affecting their participation in health insurance. Materials and Methodology:A cross-sectional descriptive study was conducted in three districts / towns / city of ThuaThien Hue in 2014. 480 subjects in the voluntary participation group who were randomly selected from the study settings were directly interviewed to collect information on the social, economic, health insurance participation and knowledge of health insurance. Test χ2 was used to identify factors related to the participation in health insurance of the study subjects. Results:42.5% of respondents were covered by health insurance scheme. Factors related to their participation were the resident location (p = 0.042); gender (p = 0.004), age (p <0.001), chronic disease (p <0.001), economic conditions (p<0.001) and knowledge about health insurance (p <0.001). Conclusion: The rate of participating health insurance among study subjects was low at 42,5%. There was "adverse selection" in health insurance scheme among voluntary participating persons. Providing knowledge about health insurance should be one of solutions to improve effectively these problems. Key words: Health insurance, voluntary, Thua Thien Hue

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Prevalence and factors associated with health insurance coverage in resource-poor urban settings in Nairobi, Kenya: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-031543 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031543 ◽

Cited By ~ 2

Author(s):

Peter O Otieno ◽

Elvis Omondi Achach Wambiya ◽

Shukri F Mohamed ◽

Hermann Pythagore Pierre Donfouet ◽

Martin K Mutua

Keyword(s):

Health Insurance ◽

Primary Outcome ◽

Insurance Coverage ◽

Scale Up ◽

Household Head ◽

Health Insurance Coverage ◽

Health Coverage ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Insurance Cover

ObjectiveTo determine the prevalence of health insurance and associated factors among households in urban slum settings in Nairobi, Kenya.DesignThe data for this study are from a cross-sectional survey of adults aged 18 years or older from randomly selected households in Viwandani slums (Nairobi, Kenya). Respondents participated in the Lown scholars’ study conducted between June and July 2018.SettingThe Lown scholars’ survey was nested in the Nairobi Urban Health and Demographic Surveillance System in Viwandani slums in Nairobi, Kenya.ParticipantsA total of 300 randomly sampled households participated in the survey. The study respondents comprised of either the household head, their spouses or credible adult household members.Primary outcome measureThe primary outcome of this study was enrolment in a health insurance programme. The households were classified into two groups: those having at least one member covered by health insurance and those without any health insurance cover.ResultsThe prevalence of health insurance in the sample was 43%. Being unemployed (adjusted OR (aOR) 0.17; p<0.05; 95% CI 0.06 to 0.47) and seeking care from a public health facility (aOR 0.50; p<0.05; 95% CI 0.28 to 0.89) was significantly associated with lower odds of having a health insurance cover. The odds of having a health insurance cover were significantly lower among respondents who perceived their health status as good (aOR 0.62; p<0.05; 95% CI 1.17 to 5.66) and those who were unsatisfied with the cost of seeking primary care (aOR 0.34; p<0.05; 95% CI 0.17 to 0.69).ConclusionsHealth insurance coverage in Viwandani slums in Nairobi, Kenya, is low. As universal health coverage becomes the growing focus of Kenya’s ‘Big Four Agenda’ for socioeconomic transformation, integrating enabling and need factors in the design of the national health insurance package may scale-up social health protection.

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Catastrophic Health Expenditures for Children with Disabilities in Iran: A National Survey

10.21203/rs.3.rs-67821/v2 ◽

2020 ◽

Author(s):

Ghobad Moradi ◽

Amjad Mohamadi Bolbanabad ◽

Farman Zahir Abdullah ◽

Hossein Safari ◽

Satar Rezaei ◽

...

Keyword(s):

Health Insurance ◽

Financial Burden ◽

Health Expenditures ◽

World Health ◽

Health Costs ◽

Financial Protection ◽

Disabled Children ◽

World Health Survey ◽

Cross Sectional ◽

Catastrophic Health Expenditures

Abstract Background: Higher health costs and financial burden are imposed on people with disabilities due to their health status associated with their disability. Measuring the incidence of catastrophic health expenditures (CHE) can provide good evidence for health policymakers to assess the current state of financial protection of the health system. The aim of this study was to investigate the percentage of households with disabled children aged 0 to 8 years who had faced CHE due to the health costs of these children in Iran.Methods: This cross-sectional study was carried out on 2000 households with disabled children aged 0 to 8 years in five provinces of Iran in 2020. Data were collected using the World Health Survey questionnaire and face-to-face interview. Households whose health expenditures for disabled members in the family were more than 40% of the household payment capacity were included in the group of households with CHE. Determinants of CHE were identified using logistic regression.Findings: 32.7% of households with disabled children had faced CHE. Head of household being female (Adjusted OR=18.89, 95%CI: 10.88- 29.42), poor economic status of the household (Q1: Adjusted OR = 20.26, 95% CI, 11.42-35.94; Q2: Adjusted OR= 8.27, 95%CI, 4.45-15.36; Q3: Adjusted OR= 13.88, 95%CI, 7.89-24.41), lack of supplementary insurance by a child with disabilities (Adjusted OR= 6.13, 95%CI, 3.39-11.26), having a child with mental disability (Adjusted OR= 2.71, 95%CI, 1.60-4.69), and type of basic health insurance [having Iranian Health Insurance: Adjusted OR= 2.20, 95%CI, 1.38-3.49; having Social security insurance: Adjusted OR= 1.66, 95%CI, 1.06-2.61] significantly increased the chances of facing CHE.Conclusion: A significant percentage of households with disabled children had faced CHE because of their disabled child's health costs. The key determinants of CHE should be considered by health policy-makers in order to more financial protection of these households.

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Private health insurance coverage-related lawsuits

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2018-0748 ◽

2020 ◽

Vol 73 (3) ◽

Author(s):

Ana Beatriz Perez Afonso ◽

Mayra Gonçalves Menegueti ◽

Thamiris Ricci de Araújo ◽

Lucieli Dias Pedreschi Chaves ◽

Ana Maria Laus

Keyword(s):

Health Insurance ◽

Private Health Insurance ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Medical Procedures ◽

Cross Sectional ◽

Positron Emission ◽

Percutaneous Rhizotomy ◽

Using Data ◽

National Regulatory Agency

ABSTRACT Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators. Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. Conclusions: the lawsuits were filed because of the operators’ refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

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Fear of catastrophic health expenditures and unrealistic expectations from supplementary health insurance: ethnic differences

International Health ◽

10.1093/inthealth/ihy089 ◽

2018 ◽

Vol 11 (4) ◽

pp. 283-289

Author(s):

Neta HaGani ◽

Samah Hayek ◽

Jalal Tarabeia ◽

Mohammad Yehia ◽

Manfred S Green

Keyword(s):

Health Insurance ◽

Health Expenditures ◽

Health Coverage ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Accessible Information ◽

Catastrophic Health Expenditures ◽

Supplementary Health Insurance ◽

Universal Health ◽

Unrealistic Expectations

Abstract Background In Israel, the whole population is covered by comprehensive universal health insurance. Despite that, most of the population purchases supplementary health insurance (SHI). It has been shown that individuals purchase more health insurance and preventive medicine when they are uncertain of their state of health, while a majority may not fully understand basic concepts in their health insurance coverage. The purpose of this study was to examine the role of fear of catastrophic health expenditures and unrealistic expectations in purchasing SHI, which does not cover expenses for life-threatening illnesses. Methods A cross-sectional survey was conducted among random samples of 814 Jews and 800 Arabs in Israel. A structured questionnaire was administered by telephone using random digit dialling. Log-linear regression was used to identify factors associated with reasons for purchasing SHI and expectations from SHI. Results The most common reason for purchasing SHI was fear of catastrophic health-related expenditures (41%). The most important service expected from SHI was ‘cancer medications’ (mean 4.68 [standard deviation 0.87]). Differences in the reasons for purchasing SHI and in expectations from SHI were found according to population group, age, gender and education. Conclusions Consumers’ misconceptions and fear of catastrophic health expenditures are major factors leading to the purchase of SHI, despite universal health coverage. Improved and accessible information should help consumers make informed decisions as to whether or not to purchase SHI.

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Understanding Subnational Variation in Chinese Social Health Insurance

Social Protection under Authoritarianism ◽

10.1093/oso/9780190073640.003.0006 ◽

2020 ◽

pp. 134-159

Author(s):

Xian Huang

Keyword(s):

Health Insurance ◽

Insurance Coverage ◽

Social Health Insurance ◽

Health Insurance Coverage ◽

Social Health ◽

Cross Sectional ◽

Insurance Benefits ◽

Social Risks ◽

Political Economies ◽

Regional Comparisons

Chapter 6 investigates the coverage and generosity of Chinese social health insurance in the first decade of the 2000s, with a focus on the regional (i.e., cross-provincial) variation using a cross-sectional time-series research design. First, a cluster analysis provides supportive evidence for the existence of four models of social health insurance expansion in China. The clustering of Chinese provinces in social health insurance expansion also corresponds to the differences among local political economies. Second, the chapter makes detailed inter-regional comparisons and intra-regional studies to reconstruct the mechanism linking a local political economy to the local distributive patterns of health insurance benefits—that is, local socioeconomic conditions shape local leaders’ policy preferences and choices for allocating social health insurance benefits in their jurisdictions. Finally, a regression analysis demonstrates significant correlations between local social risks and social health insurance coverage, and between local fiscal resources and social health insurance generosity.

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Prevalence of Self-Reported Chronic Diseases and Health Services Utilization by Ethnic Minorities in Manaus Metropolitan Region

Ethnicity & Disease ◽

10.18865/ed.28.1.49 ◽

2018 ◽

Vol 28 (1) ◽

pp. 49 ◽

Cited By ~ 4

Author(s):

Raquel Rodrigues Ferreira Rocha de Alencar ◽

Tais Freire Galvao ◽

Bruno Vianei Real Antonio ◽

Marcus Tolentino Silva

Keyword(s):

Health Insurance ◽

Chronic Diseases ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Population Based ◽

Metropolitan Region ◽

Care Utilization ◽

Cross Sectional ◽

Probabilistic Sampling ◽

Significant Difference

Objectives: To assess the prevalence of, and associated factors to, self-reported chronic diseases and health care utilization by ethnicity in the Manaus Metropolitan Region.Methods: We conducted a cross-sectional, population-based survey from May through August 2015. Using probabilistic sampling in three stages, we recruited adults aged ≥18 years. Ethnicity was self-identified as White, Black, Yellow, Brown (Brazilian mixed-race), and Indigenous. We calculated adjusted prevalence ratios (PR) and 95% CI of chronic diseases and health service utilization for each ethnic minority and compared the data using Poisson regression with data from White respondents.Results: In this study, we interviewed 4,001 people. Of these, 15.9% were White, 7.5% Black, 3.4% Yellow, 72.1% Brown, and 1.0% Indigenous. Indigenous respondents had the highest prevalence of self-reported hypertension (29.4%), diabetes (12.3%) and hypercholesterolemia (17.0%) among the ethnic respondent groups. Compared with the White population, Browns had less health insurance coverage (PR=.76; 95% CI: .62-.93) and reported hypertension (PR=.84; 95% CI: .72-0.98) and diabetes (PR=.69; 95% CI: .51-.94) less frequently. Yellows visited the doctor more frequently than Whites (PR=1.13; 95% CI: 1.04-1.22), with no significant difference in prevalence of diseases.Conclusions: Indigenous respondents had higher prevalence rates of the investigated diseases. Compared with Whites, Brown respondents had lower rates of self-reported arterial hypertension and diabetes, as well as lower rates of private health insurance coverage.Ethn Dis. 2018;28(1):49-54; doi:10.18865/ed.28.1.49

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Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

International Journal for Equity in Health ◽

10.1186/s12939-020-01372-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Leila Doshmangir ◽

Mohammad Bazyar ◽

Arash Rashidian ◽

Vladimir Sergeevich Gordeev

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Equity ◽

Universal Health Coverage ◽

Insurance Coverage ◽

Health Care Expenditures ◽

Health Insurance Coverage ◽

Health Coverage ◽

The Impact ◽

Universal Health

Abstract Background Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC. Methods This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis. Results Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable. Conclusion To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.

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