The Effect of Supplemental Health Insurance on Out-of-Pocket Payments for Elderly Households in Urban Areas of Iran: Hackman Sample Selection Model

Abstract

Objectives: Considering the growth of the elderly population and the need of the elderly for health services and the importance of supplementary insurance on improving the quality of life of the elderly households, this study aimed to investigate the effect of supplementary health insurance on out-of-pocket payments for elderly households in urban areas of Iran. Methods: this descriptive-analytical and applied study was conducted at the national level using the two-stage Hackman econometric method in Stata 16 software in 2021. The sample size was 6171 elderly households which data was extracted from different sections of the cost and income questionnaire of Iranian urban households in 2019. Results: Increasing age, education, and employment of the head of the household, increasing household size, having a private home, increasing per capita health expenditures and income of household had a positive effect on the probability of purchasing medical insurance. Increasing the age, level of education and employment of the head of the household led to an increase in out-of-pocket payments for the elderly household by 61164, 84466 and 140032 Rials per month, respectively. Having supplementary health insurance, living in provinces with high human development and being an elderly head of household increased the out-of-pocket payments to 606207, 849739 and 109274 Rials per month, respectively. Conclusion: Elderly households were less likely than other households to purchase supplementary health insurance and having supplementary health insurance by an elderly household led to an increase in out-of-pocket payments compared to other elderly households. Therefore, to reduce out-of-pocket payments, increase coverage Insurance of health goods and services required by the elderly as well as reduction of the elderly franchise is offered.

Disparities in Out-Of-Pocket Expenditures among Hospitalized COVID-19 Patients: A Decomposition Analysis of Inequality

“…The positive effect of health insurance on higher OOP expenditures has been supported by empirical studies (11,12,13). These studies highlight several reasons for this phenomenon.…”

“…Similarly, Shahraki and Ghaderi (2019) and Ahmadi and Taheri (2017) found that secondary insurance plans increased OOP expenditures among Iranian urban households and the overall Iranian population, respectively (12,13).…”

“…Shahraki and Ghaderi (2019) reported that among different types of insurance, Health Insurance, Social Security Insurance, and insurance services provided by special organizations had the most signi cant effects on OOP expenditures (13). In a study conducted in Thailand, the implementation of general insurance policies was found to reduce catastrophic health expenditures among households (8).…”

“…Mahmoud et al(2017) concluded that age could affect the OPP expenditures(11), whileAhmadi et al (2014) reported that social characteristics, such as the presence of the elderly, could increase OPP expenditures among patients(12). Other studies byShahraki and Ghaderi (2019), Ahmadi and Taheri (2017), Ghiasvand et al (2015), Ahmadi et al (2014), Panahi et al (2014), Mohammadzadeh (2014), and Savojipour et al (2018) have also revealed a direct correlation between the age of household heads and OPP expenditures(12,(14)(15)(16)(17)(18) Shahraki and Ghaderi (2019). found a strong relationship between different age groups, particularly children under the age of 7 and adults over 60, and the OOP expenditures(13).…”