Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program

Abstract

One of the important goals of Iran’s health transformation programme (HTP) is to improve financial protection for households against health expenditure. This study aimed to investigate the occurrence, intensity and inequality in distribution of catastrophic health expenditure (CHE) using the WHO and the World Bank (WB) methodologies with different thresholds in the years before and after HTP. We used data from seven annual national repeated cross-sectional surveys on households’ income and expenditures from 2011 to 2017. The intensity to CHE was calculated using overshoot and mean positive overshoot (MPO) indices. Finally, the inequality in distribution of exposure to CHE was calculated using the concentration index (CI), and the dominance test of concentration curves was used to inference about the significant changes in inequality of the years before and after HTP. The exposure rate to CHE in the total population and at 40% threshold of the WHO methodology changed from 1.99% in 2011 to 3.46% in 2017. Additionally, at 20% threshold of the WB methodology, it was changed from 5.14% to 8.68%. Overshoot and MPO indices increased on average based on two methodologies in urban and rural areas during seven years. The CIs for all the years show a negative value in both methodologies, indicating that CHE occurrence is higher among the poor households. In 2017, at 40% threshold of the WHO, the numerical values of the CIs were −0.15 and −0.14 in urban and rural populations, respectively. These values were −0.07 and −0.05 for the 20% threshold of WB, respectively. Results of dominance test showed no significant change in inequality for the years after than before HTP with two exceptions for total and rural populations based on the WB methodology. Generally, HTP had no considerable success in financial protection, requiring a review in actions to support pro-poor adaptation strategies.

What are the potential advantages and disadvantages of merging health insurance funds? A qualitative policy analysis from Iran

“…In recent years, there has been growing concern about problems attributed directly or indirectly to fragmentation in the Iranian health financing system. Among these problems are inequity in health service utilization and financial protection among different groups of people [13,16]; high out-of-pocket expenditures [12,13,17]; high occurrence and intensity of catastrophic health expenditures [18,19]; low financial protection against health services for insured people [10,20]; population coverage duplication [10,12]; failing to reach universal health coverage; lack of transparency and no reliable data in population coverage; per capita health expenditures, and contribution rates [10]. Such problems have urged policy makers to pass the 2010 Act to merge all the existing health insurance funds (basic health insurance schemes and institutional funds) into MSIO, aiming to create a single health insurance organization [9,21].…”

What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran

“…In recent years, there has been growing concern about problems attributed directly or indirectly to fragmentation in the Iranian health nancing system. Among these problems are inequity in health service utilization and nancial protection among different groups of people (13,16); high out-of-pocket expenditures (12,13,17); high occurrence and intensity of catastrophic health expenditures (18,19); low nancial protection against health services for insured people (10,20); population coverage duplication (10,12); failing to reach universal health coverage; lack of transparency and no reliable data in population coverage; per capita health expenditures, and contribution rates (10). Such problems have urged policy makers to pass the 2010 Act to merge all the existing health insurance funds (basic health insurance schemes and institutional funds) into MSIO, aiming to create a single health insurance organization (9,21).…”

What Are the Potential Advantages and Disadvantages of Merging Health Insurance Funds? A Qualitative Policy Analysis from Iran

“…Health insurance organizations in Iran are divided into three groups according to their functions: In recent years, there has been growing concern about problems attributed directly or indirectly to fragmentation in the Iranian health nancing system. Among these problems are inequity in health service utilization and nancial protection among different groups of people (13,16); high out-of-pocket expenditures (12,13,17); high occurrence and intensity of catastrophic health expenditures (18,19); low nancial protection against health services for insured people (10,20); population coverage duplication (10,12); failing to reach universal health coverage; lack of transparency and no reliable data in population coverage; per capita health expenditures, and contribution rates (10). Such problems have urged policy makers to pass the 2010 Act to merge all the existing health insurance funds (basic health insurance schemes and institutional funds) into MSIO, aiming to create a single health insurance organization (9,21).…”