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 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.

Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey

“…33 According to findings of various studies in Iran, the variables of using inpatient, outpatient, and dental services, low education, rural life and low economic status of the household, being a female head of the household, not having insurance, having a child under 5 years, having an elderly person and a person with a disability in the household are the factors that determine CHE in Iran. 30,34 According to our study, having supplementary insurance did not lead to greater financial protection and nor reduced the odds of facing CHE. This finding contradicts the findings of many previous studies.…”

“…Based on the results of the preceding 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 financial protection against CHE 33 . According to findings of various studies in Iran, the variables of using inpatient, outpatient, and dental services, low education, rural life and low economic status of the household, being a female head of the household, not having insurance, having a child under 5 years, having an elderly person and a person with a disability in the household are the factors that determine CHE in Iran 30,34 …”

The Variations in Catastrophic and Impoverishing Health Expenditures, and Its Determinants in Iran: A Scoping Review

“…The total, urban, and rural CHE incidence all showed a variable trend, ranging from 0.3 to 32.7% for total households. The lowest percentage of CHE in the studies conducted from 2000 to 2020 at the national population level is reported by Hajizadeh M et al in 2003 among 3514 Iranian households using hospital services(0.3%) ( 23 ), while the highest percentage of CHE rate is reported by Moradi, G et al in 2020 among 2000 Iranian households with disabled children aged 0 to 8 years (32.7.3%) ( 24 ). Further analysis reveals that the percentage of CHE is 3.83% in studies that use primary data (N:13) and 3.37% in studies that use secondary data (N:42).…”

“…Studies with primary data use the questionnaires and interviews for data collection, while those with secondary data use data from the Household Income and Expenditure Survey (HIES) which is collected regularly by the Iran Statistics Center (ISC). Among reviewed studies, three studies conducted at the national level have declared higher CHE percentages (15.31% in 2001 ( 25 ), 11.58% in 2013 ( 23 ), and 32.7% in 2020 ( 24 )) which have increased the overall mean of CHE from 2.48% to 3.19 %.…”

“… 54 Woldemichael, A et al 2021 ( 108 ) Analyses impact of OOP payments for dental services on prevalence CHE among Iranian households during 2018. cross-sectional analysis WHO method Yes United Nations designed and approved questionnaire Original Article/ English 2018 Iranian households Determinants of exposure to CHE: Demographic variables: Sex of household head (Female+), Age of household head (≥ 66 +), Household had ≤5-year-old child (No+), Household had ≥66-year-old member (Yes+), Socioeconomic variables: Educational status of household head (illiterate+), Wealth index of households (Poorest+) , Insurance coverage (Yes+) , Ecological variables: Geographical location of household (Rural +), HDI*of province (High +) 55 Moradi, G et al 2021 ( 24 ) 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. cross-sectional study WHO method Yes WHO questionnaire Original Article/ English 2020 Households with disabled children aged 0 to 8 years in five provinces in Iran Determinants of exposure to 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((having Iranian Health Insurance+).…”