Analysis of Iranian household financial participation in the health system: Decomposition of the concentration index approach

authors:

avatar Amir Abbas Fazaeli , * , avatar ali akbar fazeeli ORCID , avatar Yadollah Hamidi , avatar Babak Moeini , avatar A. li Valinejadi

Koomesh: Vol.20, issue 2; 358-365
article type: issue_documents_importer
received: August 01, 2017
accepted: January 02, 2018

how to cite: Fazaeli A A, fazeeli A A, Hamidi Y, Moeini B, Valinejadi A L. Analysis of Iranian household financial participation in the health system: Decomposition of the concentration index approach. koomesh. 2024;20(2):e152966. 

Abstract

Introduction: The status of financial participation of individuals in health financing is one of the challenging issues in assessing the performance of health systems in the world. The concern about the financing of the health system and its consequences on Iranian households from about a decade ago is a turning point in attracting the attention of researchers and policymakers to this area. This study has been calculated financial contribution of people in Iran health system in 2015. Materials and Methods: Using cost-income information of 38252 Iranian households collected by the Statistical Center of Iran in 2015, the distribution of health expenditures of households based on the income approach is calculated and factors influencing the concentration index are measured. Results: The results showed that the concentration index of health care expenditures in Iran was 0.3318. This is indicative of the progressive status of household participation in financing the health system. Also, dental expenditures with the index of 0.496 have the highest inequality in the distribution of health care expenditures. Payment for hospital services and dental care services had the highest share in increasing the coefficient index. Conclusion: Having insurance coverage as one of the most important policy tools to achieve the desired model of household financial participation has a significant effect on the distribution of financial participation of households and the most important factor in reducing the coefficient of concentration index

References

  • 1.

    Moghadam MN, Banshi M, Javar MA, Amiresmaili M, Ganjavi S. Iranian household financial protection against catastrophic health care expenditures. Iran J Public Health 2012; 41: 62-70.

  • 2.

    Fazaeli AA, Ghaderi H, Salehi M, Fazaeli AR. Health care expenditure and gdp in oil exporting countries: evidence from opec data, 1995-2012. Global J Health Sci 2016; 8: 93-98.

  • 3.

    Yardim MS, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy 2010; 94: 26-33.

  • 4.

    Onoka CA, Onwujekwe OE, Hanson K, Uzochukwu BS. Examining catastrophic health expenditures at variable thresholds using household consumption expenditure diaries. Trop Med Int Health 2011; 16: 1334-1341.

  • 5.

    Kim Y, Yang B. Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea. Health Policy 2011; 100: 239-246.

  • 6.

    Fazaeli AA, Seyedin H, Moghaddam AV, Delavari A, Salimzadeh H, Varmazyar H, Fazaeli AA. Fairness of financial contribution in Iranian health system: trend analysis of national household income and expenditure, 2003-2010. Global J Health Sci 2015; 7: 260-265.

  • 7.

    Fazaeli AA, Ghaderi H, Fazaeli AA, Lotfi F, Salehi M, Mehrara M. Main determinants of catastrophic health expenditures: a Bayesian logit approach on Iranian household survey data (2010). Global J Health Sci 2015; 7: 335-340.

  • 8.

    Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. The Lancet 2003; 362: 111-117.

  • 9.

    Ghiasvand H, Olyaeemanesh A, Majdzadeh R, Abdi Z, Mobinizadeh M. Has the financial protection been materialized in Iranian health system? analyzing household income and expenditure survey 2003-2014. J Res Health Sci 2018; 18. (Persian).

  • 10.

    Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Nabukhonzo P, Aguilar AM. Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc Sci Med 2006; 62: 866-876.

  • 11.

    Iran IPo. Fifth five-year national development plan of Iran 2005-2009. 2011 [Last accessed on 22 October 2016]. Available from: http://rc.majlis.ir/fa/law/show/790196.

  • 12.

    Wagstaff A, Van Doorslaer E, Van der Burg H, Calonge S, Christiansen T, Citoni G, et al. Equity in the finance of health care: some further international comparisons. J Health Econ 1999; 18: 263-290.

  • 13.

    Wagstaff A, Van Doorslaer E. Paying for health care: quantifying fairness, catastrophe, and impoverishment, with applications to Vietnam, 1993-98: World Bank, Development Research Group, Public Services for Human Development; 2001.

  • 14.

    Hajizadeh M, Nghiem HS. Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments? Int J Health Care Finance Econ 2011; 11: 267-285.

  • 15.

    Zare H, Trujillo AJ, Driessen J, Ghasemi M, Gallego G. Health inequalities and development plans in Iran; an analysis of the past three decades (19842010). Int J Equity Health 2014; 13: 42.

  • 16.

    Kakwani NC. Measurement of tax progressivity: an international comparison. The Econ J 1977; 87: 71-80.

  • 17.

    Murray CJ, Knaul FM, Ke X, Musgrove P, Kawabata K. Defining and measuring fairness in financial contribution to the health system. 2000.

  • 18.

    Clarke PM, Gerdtham UG, Connelly LB. A note on the decomposition of the health concentration index. Health Econ 2003; 12: 511-516.

  • 19.

    Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F, Hosseinpour AR, Mohammad K, Arab M. Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan 2012; 27: 613-623.

  • 20.

    Mohammadalizadeh Hanjani H, Fazaeli A. Equity status in Iran Health system financing. Soc Welfare J 2008; 5: 289-299.

  • 21.

    Kazemian M, Abolhalaj M, Nazari H. Assessment of equity in public health care financing in 2013. J Clin Nurs Midwifery 2017; 6: 64-72. (Persian).

  • 22.

    Mondal S. Health care services in India: A few questions on equity. Health 2013; 5: 53.

  • 23.

    Ghafoori MH, Azar FE, Arab M, Mahmoodi M, Zadeh NY, Rezapour A. Inequality in the distribution of health expenditures in 22 districts of Tehran. J Commun Health Res 2014; 3. (Persian).##.