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

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.

Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%? The results of a national study

“…The difference in the percentage of CHE between provinces was not signi cant.Based on the ndings of this study, in the last year of the sixth ve-year development plan (2017-2021) as a strategic document, like the two previous development plans,Iran not only did not achieve the goal of reducing the percentage of households exposed to CHE to 1% and there is still a big gap to reach that goal, but also, based on the ndings of previous studies, this gap seems to have become deeper [15][16][17]. According to the ndings of another [23]. Also, according to the report of the research center of the Iranian parliament, the value of the CHE index for the country at the end of 2015 (end of the fth development plan) was reported 6% [18].A comparison of the ndings of our study with the ndings of the above studies conducted in recent years shows that the status of the nancial protection index against CHE in Iran not only did not reach the 1% target but rather the gap between the status quo with a predetermined goal and the desired status seems to have widened [15,17,22].…”

“…The difference in the percentage of CHE between provinces was not signi cant.Based on the ndings of this study, in the last year of the sixth ve-year development plan (2017-2021) as a strategic document, like the two previous development plans,Iran not only did not achieve the goal of reducing the percentage of households exposed to CHE to 1% and there is still a big gap to reach that goal, but also, based on the ndings of previous studies, this gap seems to have become deeper [15][16][17]. According to the ndings of another systematic and meta-analysis study in Iran (2017) conducted by Ghorbaian et al, the prevalence of households faced with CHE was reported to be 3.9% (95% CI, 3.26-11.07) [22].. Also, in the latest systematic and meta-analysis study in Iran (2018) conducted by Aryankhesal et al, in total, the percentage of households exposed to CHE was 7.5% (95% CI, 6.2-9.1) and for inpatient services was 35.9% (95% CI, 23.5-54.3) [15].Based on a national study in Iran (2020) conducted by Moradi et al on households with disabled children, 32.7% of households were exposed to CHE [23]. Also, according to the report of the research center of the Iranian parliament, the value of the CHE index for the country at the end of 2015 (end of the fth development plan) was reported 6% [18].A comparison of the ndings of our study with the ndings of the above studies conducted in recent years shows that the status of the nancial protection index against CHE in Iran not only did not reach the 1% target but rather the gap between the status quo with a predetermined goal and the desired status seems to have widened [15,17,22].…”

“…Based on the results of the study, the expansion of prepayment mechanisms, integration of insurance funds and designing insurance service packages to cover chronic diseases have been proposed as appropriate solutions for nancial protection against CHE [26]. Findings of another systematic and meta-analysis study in Iran (2019) indicated that the variables of using inpatient, outpatient, and dental services, low education, rural life and low household income are the factors that determine CHE in Iran, and these variables increase the odds of encountering CHE [22,23]. In another study in Iran (2020) on households with children with disabilities, the variables of female head of household, poor economic status of the household, lack of supplementary insurance and type of basic health insurance signi cantly increased the chances of facing CHE.…”