The Prevalence and Determinants of Catastrophic Health Expenditures in Iran: A Systematic Review and Meta-Analysis

Abstract

Objective: In this systematic review, we aimed at estimating the pooled prevalence of catastrophic health expenditures (CHE) in Iran and identifying and summarizing the determinants of CHE among Iranian households. Methods:We comprehensively searched the literature on November 2016 in PubMed, Scopus, Web of Science, the Cochrane Library, and 3 Persian databases. We also obtained the literature through colleague communications. Two review authors independently selected studies, extracted data, and evaluated them. We performed meta-analysis of prevalence of CHE and subgroup meta-analyses to assess the influence of data source and scope of research. Moreover, we categorized the determinants of CHE in Ian.Results: In this review, 16 studies met the inclusion criteria, and of them, 2 presented the results of multiple surveys. Results of 27 cross-sectional studies were used to estimate the pooled prevalence of CHE in Iran during 1995 and 2015, which was found to be 3.91% (95% confidence interval, CI: -3.26-11.07). Subgroup meta-analyses based on data source revealed that the highest prevalence estimate of facing CHE was associated with author-made questionnaires, and the lowest to the statistical Centre of Iran (SCI) questionnaire. Also, meta-regression showed that the difference in sample size and year of study did not have any significant effect on the prevalence of CHE. Some of the variables such as use of inpatient, outpatient, and dentistry services, education, place of residence, and household income, which were considered as determinants of CHE in Iran, increased the possibility of facing CHE. Conclusions:Decrease in CHE to less than 1%, which was the objective of the 2 of Iran's five-year development plans in 2007 and 2015, was not met. This percentage may need to be reconsidered according to the pooled estimate of CHE. Also, the factors revealed to be the determinants of an increase in the probability of facing CHE could indicate the need for health care services and socioeconomic variables that lower one's capacity to pay for health services.

A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

“…At 40% of capacity to pay, 6.6% to 63.6% of Nigerian households incurred financial catastrophe while accessing health care. In contrast, similar reviews have found that smaller proportions of households experienced CHE at this same threshold . Similarly, a study conducted using the Kenya Household Health Expenditures and Utilization Survey data of 2007 found that 11.7% of households experienced catastrophic expenditures and 4% were impoverished by health care payments .…”

<p>Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality</p>

“…Identifying the imposed financial risk on diabetic patients due to health-care costs and the other related factors can lead to more effective efforts to alleviate this problem. 11 Many studies have been conducted on health-care expenditures and have examined the incidence of CHE among households in Iran 17,[22][23][24] but no studies have been done so far among the diabetics on the index of CHE which causes poverty. A study by Rezaei and Hajizadeh 25 showed that 5.26% of Iranian households faced CHE in 2017.…”

Which groups of the poor are supported more by the law? Pro‐poor health policy network in Iran

“…Despite the emphasis placed on health financial support provision for people with disability and the elderly, yet disability and aging are identified as risk factors for dealing with catastrophic health expenditures in the upstream documents . Evidence shows that there is no specific strategy to support people with disability to have access to healthcare services and health insurance beyond the basic coverage .…”

“…Despite the emphasis placed on health financial support provision for people with disability and the elderly, yet disability and aging are identified as risk factors for dealing with catastrophic health expenditures in the upstream documents. 33 Evidence shows that there is no specific strategy to support people with disability to have access to healthcare services and health insurance beyond the basic coverage. 34 Therefore, the development of targeted policies to guarantee the full coverage of these groups and effective institutional coherence will be a key step toward achieving ideal financial supports for such vulnerable groups.…”