<p>Explaining Socioeconomic Inequality Differences in Catastrophic Health Expenditure Between Urban and Rural Areas of Iran After Health Transformation Plan Implementation</p>

Abstract

Objective Ensuring fair financial contribution is one of the main goals of the Health Transformation Plan (HTP) of Iran. This study aims to estimate socioeconomic inequality differences in catastrophic health expenditure (CHE) between urban and rural areas of Iran after the implementation of the HTP during 2017. Materials and Methods Data from a representative survey of households’ income and xpenditure from the Iran Statistical Center (ISC) were used for the analysis. We applied the World Health Organization (WHO) cut-off of 40% payment for CHE, and Wagstaff’s normalized concentration index ( C ) to measure and decompose the inequality. Also, Blinder–Oaxaca decomposition analysis was used to decompose contributors of inequality differences between rural and urban areas. Results The overall incidence of CHE among Iranian households during the year 2017 was 3.32% with a standard deviation (SD) of 17.91%, and the mean (SD) levels of CHE in rural and urban areas of Iran were 4.37% (20.45%) and 2.97% (16.99%), respectively. The aggregate socioeconomic status (SES)-related inequality in CHE was significantly ( p <0.001) different from zero ( C =−0.238) and there was a significant ( p <0.05) difference between rural ( C =-0.150) and urban ( C =0.218) areas. SES was the highest contributor to inequality in both rural (130.09) and urban (144.17) areas. The Blinder–Oaxaca decomposition revealed that SES (175.01%) followed by outpatient services (120.29%) were the main contributors to differences in inequality in rural and urban areas. Sex (−101.42%) and health insurance coverage were among negative contributors to this inequality difference. Conclusion Our findings revealed a significant pro-rich inequality in CHE. Also, some variables, such as sex and region, made different contributions in rural and urban areas. However, SES, itself, made the highest contribution in both areas and explained the greatest share of difference in inequality between the two areas. This issue calls for revision of the HTP to further address the risk of CHE and socioeconomic disparity among Iranian households, especially those with lowSES.

Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature

“…Records identified from databases (total n = 5, 849): [114]; [115]; [116]; [117]; [118]; [119]; [120]; [56]; [58]; […”

“…The results from examining the protective effect of different health insurance schemes (Additional file 7) suggest that health insurance in LMICs did not consistently offer a higher degree of FRP. Even though insurance lowered CHE in six studies (in Ghana, Iran, Peru, Thailand and Viet Nam) [34,[52][53][54][55][56], three studies reported higher CHE in India, Iran and Kenya [57][58][59], and another three studies reported not necessarily lower CHE in Colombia, Mexico and Vietnam [60][61][62]. Again, two of these studies showed mixed results: insured households incurred higher CHE but lower impoverishment than the noninsured in India [57], and CHE decreased but impoverishment increased just after launching the Health Transformation Plan in Iran [56].…”

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

“… Original Article/ English 1991 to 2017 Iranian households 48 Abdi,ZH et al 2020 ( 35 ) Undertake a descriptive analysis of changes in health spending associated with implementation of the latest health sector reform in Iran, namely the Health Transformation Plan (HTP). descriptive analytical study WHO method NO Secondary data Original Article/ English 2014 and 2015 Iranian households 49 Kazemi-Karyani, Ali et al 2020 ( 103 ) Estimate socioeconomic inequality differences in CHE between urban and rural areas of Iran after the implementation of the HTP during 2017. Representative survey WHO method, Wagstaff’s normalized concentration index Yes Secondary data Original Article/ English 2017 Iranian households Determinants of exposure to CHE: Socioeconomic status (SES) (+), outpatient services (+), health insurance coverage (-).Sex(Female headed)(+), households with an elderly person(+), with no under-5-year-old children(+), with a family size of 1–2 people (+), living in rural areas (+), with individuals having chronic specific diseases (+), and those who utilize inpatient (+) and outpatient (+), region of residency (+).…”

The influence of the National Health Insurance scheme of the Lao People’s Democratic Republic on healthcare access and catastrophic health expenditures for patients with chronic renal disease, and the possibility of integrating organ transplantation into the health financing system

“…Invariably, as financial barriers to health insurance coverage are reduced, problems with physical access to medicines, technology and other necessary services can be effectively addressed by such collaborative partnerships. Moreover, because health insurance funds practically come with patients, the health system’s responsiveness is anticipated to improve due to increasing competition among providers [ 43 ].…”