Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households

Abstract

Objectives: Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.Methods: This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.Results: Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.Conclusions: In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics

“… 14 Inequality in health service utilization not only affects individuals, but also has a negative impact on labor market productivity and ultimately, gross domestic product. 15 There is clear evidence showing that healthcare services utilization has not been equally distributed among different socioeconomic groups 16 - 18 that goes against basic human rights. 4 , 19 , 20 Studies conducted in both developed and developing countries have demonstrated that residents in affluent areas are more likely to utilize health services when they become sick compared to their counterparts in poorer areas.…”

Decomposed Trends of Iranian Private Health Expenditures: Should Inequality be Appreciated?

“…This may have an impact on the efficiency of the health care system. Therefore, the status of OPHP will not only determine households' access to health care services, but can also affect their well-being through income allocation to health care and other needs (5)(6)(7)(8).…”

“…For instance, in 2011 an exchange rate shock in Iran, severely damaged people's purchasing power and reduced their capacity to pay for health care (5), including for those who had indispensable and continuous need for health care services, such as people with disabilities or rare diseases. As a result, health services may be pushed out of affordability for some families.…”