Background COVID-19 is a public health emergency with a high mortality rate and it reduces the patient’s Health-Related Quality of Life (HRQoL) significantly. This effect is measured in the current study. Methods In a cross-sectional study in Iran, 320 randomly selected treated patients from COVID-19 were studied. To collect the required data, we applied a questionnaire that included socio-demographic factors, clinical characteristics, and questions on the patients’ HRQoL. Time trade-off (TTO) approach was used to measure the lost HRQoL attributed to COVID-19. Besides, we applied a two-limit Tobit regression model to determine the effects of the socio-demographic factors on patients’ health utility and the visual analogue scale approach was used to estimate the perceived total current health status. Results The overall mean (SE) and median (IQR) of the health utility values were 0.863 (0.01) and 0.909 (0.21) respectively. These values for the traders (those who were willing to lose a part of their remaining time of life to avoid the disease) were estimated at 0.793 (0.01) and 0.848 (0.17), respectively. The lowest amount of utility value belonged to the elderly (mean (SE) = 0.742 (0.04); median (IQR) = 0.765 (0.42)) and those living in rural areas (mean (SE)) = 0.804 (0.03); median (IQR) = 0.877 (0.30)). The univariate analysis showed that age, place of residence, and household size had a statistically significant effect on health utility. Moreover, findings of the regression analysis indicated that the participants’ age and hospitalization status were the key determinants of COVID-19 health utility value. Conclusion COVID-19 is associated with a substantial and measurable decrease in HRQoL. This decline in HRQoL can be directly compared with that induced by systemic health states.

Purpose The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran). Design/methodology/approach This is a cross-sectional study conducted on 800 elderly people in Sanandaj. Subjects were selected using multistage sampling and data were collected using self-report questionnaires. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with seeking perceived need. Also, the concentration index was used to measure the inequality in using health services. Findings The perceived need for outpatient (during the last 30 days) and inpatient health-care services (during the past 12 months) was 69.7% and 29.7%, respectively. Among them, the unmet need for outpatient and inpatient health-care services was 46.6% and 17%, respectively. Having health insurance (adjusted OR 12.08; 95% confidence interval [CI] 1.04–140.11), middle economic status (adjusted OR 5.18; 95% CI 1.30–20.51) and being in an age group of 65–70 years (adjusted OR 7.60; CI 1.42–40.61) increased the chance of seeking inpatient care. Also, being in an age group of 60–65 years (adjusted OR 0.41; 95% CI 0.18–0.95) reduced the chance of seeking outpatient care. There was also a pro-rich inequality in using outpatient health services. Originality/value The elderly population suffers from unmet health-care needs, especially in outpatient services. The most important reason for not seeking outpatient and inpatient services was financial barriers and self-medication, respectively. So, designing targeted policies and interventions to address barriers in the conversion of need to demand in the elderly population is essential.

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.

Background: Little information exists on properties of EQ-5D-5L (the 5L hereafter) compared to the EQ-5D-3L (the 3L hereafter) measures in the context of Iran. This study aims to compare the measurement properties of the two versions of the EQ-5D (the 3L vs. the 5L) using data obtained from general population in Iran.Methods: A total of 886 adults aged 18 years and above from September to November 2020 participated in this cross-sectional analysis. The required data collected using self-administered and-standard questionnaire and multistage sampling method was used to select the samples. The 3L and 5L measures compared in terms of celling effect, distribution and redistribution pattern, feasibility, convergent validity, know-groups validity and informativity.Results: From September to November 2020, 886 adults (mean aged = 44.6 years; 55% male and 87.1% married) included in the study. The study indicated that the 5L had lower celling effects compared to the 3L (45% vs. 46%). A better convergent validity and known-groups validity was found for the 5L version compared to the 3L and significantly stronger association found between the 5L measure with both the Visual Analogue Scale and the 5-point health status scale. The 5L index score showed higher relative efficiency (RE) in 9 of 11 condition (mean RE = 1.36).Compared to the 3L, the 5L classification system had higher Shannon index (H 0 ) in all dimensions: mobility (0.52 vs.

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 regression analysis.Findings: 32.7% of households with disabled children had faced CHE. Head of household being female, poor economic status of the household, lack of supplementary insurance by a child with disabilities, having a child with mental disability and type of basic health insurance 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. More financial protection of these households against health costs should be on the agenda of health policy makers. Implementation of payment exemption programs, direct and indirect financial support programs and having prepaid mechanisms are suggested to reduce out-of-pocket payments for health services.