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Cited by 46Healthcare Systems and ReformsEconomic and Financial Impacts of CancerHealthcare Policy and Management

Determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis

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Doshmangir, Leila, Yousefi, Mahmood, Hasanpoor, Edris, Eshtiagh, Behzad, Haghparast-Bidgoli, Hassan·2020·Cost Effectiveness and Resource Allocation
DOI 10.1186/s12962-020-00212-0PMC PMC7229629
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Abstract

Background: Catastrophic health expenditures (CHE) are of concern to policy makers and can prevent individuals accessing effective health care services. The exposure of households to CHE is one of the indices used to evaluate and address the level of financial risk protection in health systems, which is a key priority in the global health policy agenda and an indicator of progress toward the UN Sustainable Development Goal for Universal Health Coverage. This study aims to assess the CHE at population and disease levels and its influencing factors in Iran. Methods: This study is a systematic review and meta-analysis. The following keywords and their Persian equivalents were used for the review: Catastrophic Health Expenditures; Health Equity; Health System Equity; Financial Contribution; Health Expenditures; Financial Protection; Financial Catastrophe; and Health Financing Equity. These keywords were searched with no time limit until October 2019 in PubMed, Web of Science, Scopus, ProQuest, ScienceDirect, Embase, and the national databases of Iran. Studies that met a set of inclusion criteria formed part of the meta-analysis and results were analyzed using a random-effects model. Results: The review identified 53 relevant studies, of which 40 are conducted at the population level and 13 are disease specific. At the population level, the rate of CHE is 4.7% (95% CI 4.1% to 5.3%, n = 52). Across diseases, the percentage of CHE is 25.3% (95% CI 11.7% to 46.5%, n = 13), among cancer patients, while people undergoing dialysis face the highest percentage of CHE (54.5%). The most important factors influencing the rate of CHE in these studies are health insurance status, having a household member aged 60–65 years or older, gender of the head of household, and the use of inpatient and outpatient services. Conclusion: The results suggest that catastrophic health spending in Iran has increased from 2001 to 2015 and has reached its highest levels in the last 5 years. It is therefore imperative to review and develop fair health financing policies to protect people against financial hardship. This review and meta-analysis provides evidence to help inform effective health financing strategies and policies to prioritise high-burden disease groups and address the determinants of CHE.

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  • The review's findings are consistent with findings in comparable regions such as Southeast Asia and South America.

    “Our findings are consistent with findings in comparable regions such as Southeast Asia [105, 106] and South America [107, 108].”

    From Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review (2022) · cites this paper as [105]

    The Discussion (page unavailable) says the review’s finding about household economic status as a determinant of catastrophic health expenditure accords with studies in other countries, including Vietnam in Southeast Asia. Our copy does not establish a corresponding comparison with findings from South America; a Brazilian study appears in the References, but the cited passages do not compare its findings with the review’s. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • The study is a methodological improvement on previous studies because it used several measures of catastrophic health expenditure.

    “The study is a methodological improvement on previous studies as we used several measures of catastrophic health expenditure.134,139,143,144”

    From Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis (2022) · cites this paper as [134]

    The citing sentence’s “we used several measures” describes the citing authors’ own study, not Doshmangir et al.’s. In the cited paper’s Results sections on population- and disease-level CHE, both sets of results are reported at a 40% income threshold; its Background describes alternative ways to define CHE, but does not assess the citing study’s methods or its claimed improvement over previous studies. (LLM, conf=0.75)

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References 89 · Cited by 46

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  1. [2]Jakovljevic M Timofeyev Y Ekkert NV Fedorova JV Skvirskaya G Bolevich S The impact of health expenditures on public health in BRICS nations J Sport Health Sci 2019 8 6 516 31720060 PMC6835015
  2. [3]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 9 62 23193508 PMC3494217
  3. [4]Grima S Spiteri JV Jakovljevic M Camilleri C High out-of-pocket health spending in countries with a mediterranean connection Front Public Health. 2018 6 145 29876340 PMC5974227
  4. [5]Jakovljevic MB BRIC’s growing share of global health spending and their diverging pathways Front Public Health. 2015 3 135 26000273 PMC4421927
  5. [6]Jakovljevic M Camilleri C Rancic N Grima S Jurisevic M Grech K Cold war legacy in public and private health spending in Europe Front Public Health 2018 6 215 30128309 PMC6088206
  6. [7]Yardim MS Cilingiroglu N Yardim N Catastrophic health expenditure and impoverishment in Turkey Health Policy 2010 94 1 26 33 19735960
  7. [8]Chang AY Cowling K Micah AE Chapin A Chen CS Ikilezi G Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050 Lancet. 2019 393 10187 2233 2260 31030984 PMC6548764
  8. [9]Sachs JD From millennium development goals to sustainable development goals Lancet. 2012 379 9832 2206 2211 22682467
  9. [11]Abolhallaje M Hasani S Bastani P Ramezanian M Kazemian M Determinants of catastrophic health expenditure in Iran Iran J Public Health. 2013 42 Supple1 155 23865034 PMC3712590
  10. [13]Ekman B Catastrophic health payments and health insurance: some counterintuitive evidence from one low-income country Health Policy 2007 83 2–3 304 313 17379351
  11. [14]Gartoulla P Liabsuetrakul T Chongsuvivatwong V McNeil E Ability to pay and impoverishment among women who give birth at a University Hospital in Kathmandu, Nepal Glob Public Health. 2012 7 10 1145 1156 23083138
  12. [15]Xu K Evans DB Carrin G Aguilar-Rivera AM Musgrove P Evans T Protecting households from catastrophic health spending Health Aff 2007 26 4 972 983 17630440
  13. [16]Van Doorslaer E O’Donnell O Rannan-Eliya RP Somanathan A Adhikari SR Garg CC Catastrophic payments for health care in Asia Health Econ 2007 16 11 1159 1184 17311356
  14. [17]Xu K Evans DB Kadama P Nabyonga J Ogwal PO Nabukhonzo P Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda Soc Sci Med 2006 62 4 866 876 16139936
  15. [18]Ghoddoosinejad J Jannati A Gholipour K Baghestan EB Households encountering with catastrophic health expenditures in Ferdows, Iran J Egypt Public Health Assoc 2014 89 2 81 84 25162739
  16. [20]Moher D Liberati A Tetzlaff J Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement Ann Intern Med 2009 151 4 264 269 19622511
  17. [22]Higgins JP Thompson SG Deeks JJ Altman DG Measuring inconsistency in meta-analyses BMJ 2003 327 7414 557 560 12958120 PMC192859
  18. [23]Aeenparast Rezaei Zandian Haeri-Mehrizi Catastrophic health expenditures in Iran: a review of the literature Payesh. 2016 15 1 7 17
  19. [27]Azzani M Yahya A Roslani AC Su TT Catastrophic health expenditure among colorectal cancer patients and families: a case of Malaysia Asia Pac J Public Health. 2017 29 6 485 494 29019257
  20. [28]Daneshkohan A Karami M Najafi F Matin BK Household catastrophic health expenditure Iran J Public Health. 2011 40 1 94 23113061 PMC3481728
  21. [31]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) Glob J Health Sci 2015 7 4 335 25946936 PMC4802182
  22. [32]Fazaeli AA Seyedin H Moghaddam AV Delavari A Salimzadeh H Varmazyar H Fairness of financial contribution in Iranian health system: trend analysis of national household income and expenditure, 2003–2010 Glob J Health Sci 2015 7 5 260 26156920 PMC4803859
  23. [35]Ghiasvand H Gorji HA Maleki M Hadian M Catastrophic health expenditure among Iranian rural and urban households, 2013–2014 Iran Red Crescent Med J. 2015 17 9 1 12 PMC4601211 26473081
  24. [38]Ghiasvand H Sha’baninejad H Arab M Rashidian A Hospitalization and catastrophic medical payment: evidence from hospitals located in Tehran Arch Iran Med. 2014 17 7 507 513 24979565
  25. [39]Ghorbanian A Rashidian A Lankarani KB Kavosi Z The prevalence and determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis Health Scope. 2019 8 1 1 16
  26. [40]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 Financ Econ. 2011 11 4 267 21915727
  27. [41]Homaie Rad E Rashidian A Arab M Souri A The effect of catastrophic health expenditure on work after retirement Int J Aging Hum Dev 2017 84 3 313 323 28195015
  28. [42]Juyani Y Hamedi D Jebeli SSH Qasham M Multiple sclerosis and catastrophic health expenditure in Iran Glob J Health Sci 2016 8 9 194 PMC5064064 27157166
  29. [43]Karami M Najafi F Karami Matin B Catastrophic health expenditures in Kermanshah, west of Iran: magnitude and distribution J Res Health Sci 2009 9 2 36 40 23344170
  30. [44]Kavosi Z Keshtkaran A Hayati R Ravangard R Khammarnia M Household financial contribution to the health System in Shiraz, Iran in 2012 Int J Health Policy Manag 2014 3 5 243 25337598 PMC4204743
  31. [46]Kavosi Z Rashidian A Pourreza A Majdzadeh R Pourmalek F Hosseinpour AR Inequality in household catastrophic health care expenditure in a low-income society of Iran Health Policy Plan 2012 27 7 613 623 22279081
  32. [50]Moradi G Safari H Piroozi B Qanbari L Farshadi S Qasri H Catastrophic health expenditure among households with members with special diseases: a case study in Kurdistan Med J Islamic Republic Iran. 2017 31 43 PMC5804459 29445672
  33. [53]Piroozi B Moradi G Nouri B Bolbanabad AM Safari H Catastrophic health expenditure after the implementation of health sector evolution plan: a case study in the west of Iran Int J Health Policy Manag 2016 5 7 417 27694669 PMC4930347
  34. [55]Rezapour A Arabloo J Tofighi S Alipour V Sepandy M Mokhtari P Determining Equity in Household’s Health Care Payments in Hamedan Province Iran. Arch Iran Med. 2016 19 7 480 493 27362241
  35. [62]Anbari Z Mohammadbeigi A Mohammadsalehi N Ebrazeh A Health expenditure and catastrophic costs for inpatient-and out-patient care in Iran Int J Prev Med 2014 5 8 1023 25489451 PMC4258666
  36. [66]Xu K Evans DB Kawabata K Zeramdini R Klavus J Murray CJ Household catastrophic health expenditure: a multicountry analysis Lancet. 2003 362 9378 111 117 12867110
  37. [68]Jakovljevic M Malmose-Stapelfeldt C Milovanovic O Rancic N Bokonjic D Disability, work absenteeism, sickness benefits, and cancer in selected european OecD countries—forecasts to 2020 Front Public Health. 2017 5 23 28289676 PMC5327442
  38. [69]Tripathy J Prasad B Shewade H Kumar A Zachariah R Chadha S Cost of hospitalisation for non-communicable diseases in India: are we pro-poor? Trop Med Int Health 2016 21 8 1019 1028 27253634
  39. [70]Group AS Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: results from the ACTION Study Surgery. 2015 157 6 971 982 25934082
  40. [71]Lee J-E Shin H-I Do YK Yang EJ Catastrophic health expenditures for households with disabled members: evidence from the Korean health panel J Korean Med Sci 2016 31 3 336 344 26955233 PMC4779856
  41. [72]Ma X Wang Z Liu X Progress on Catastrophic Health Expenditure in China: evidence from China Family Panel Studies (CFPS) 2010 to 2016 Int J Environ Res Public Health. 2019 16 23 4775 PMC6926556 31795178
  42. [74]Berki S A look at catastrophic medical expenses and the poor Health Aff 1986 5 4 138 145 3102333
  43. [78]Somkotra T Lagrada LP Which households are at risk of catastrophic health spending: experience in Thailand After universal coverage: exploring the reasons why some households still incur high levels of spending—even under universal coverage—can help policymakers devise solutions Health Aff 2009 28 Suppl1 w467 w478 19336470
  44. [79]Wagstaff A Lindelow M Can insurance increase financial risk?: the curious case of health insurance in China J Health Econ 2008 27 4 990 1005 18342963
  45. [81]Barros AJ Bastos JL Dâmaso AH Catastrophic spending on health care in Brazil: private health insurance does not seem to be the solution Cadernos de saude publica. 2011 27 s254 s262 21789417
  46. [82]Galárraga O Sosa-Rubí SG Salinas-Rodríguez A Sesma-Vázquez S Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico Eur J Health Econ 2010 11 5 437 447 19756796 PMC2888946
  47. [83]Li Y Wu Q Xu L Legge D Hao Y Gao L Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance Bull World Health Organ 2012 90 664 671 22984311 PMC3442391
  48. [85]Van Minh H Phuong NTK Saksena P James CD Xu K Financial burden of household out-of pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002–2010 Soc Sci Med 2013 96 258 263 23246399
  49. [86]Su TT Kouyaté B Flessa S Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso Bull World Health Organ 2006 84 21 27 16501711 PMC2626518
  50. [87]Adhikari SR Maskay NM Sharma BP Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences Health Policy Plan 2009 24 2 129 139 19181674
  51. [88]Wagstaff A Doorslaer EV Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998 Health Econ 2003 12 11 921 933 14601155

Authors
Doshmangir, L., Yousefi, M., Hasanpoor, E., Eshtiagh, B., & Haghparast-Bidgoli, H.
Affiliations
  • Tabriz University of Medical Sciences (IR)
  • Maragheh University of Medical Sciences (IR)
Corresponding author
Hasanpoor, Edris
ORCID
Venue
Cost Effectiveness and Resource Allocation
Publisher
Springer Science and Business Media LLC
Published
2020-05-15
Volume
18
Issue
1
Pages
17-17
ISSN
1478-7547 (ISSN-L)
DOI
10.1186/s12962-020-00212-0
PMC
PMC7229629
OpenAlex
W3030505316
Cited by
46
References
89
Citations by year
2026: 6 · 2025: 7 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 18 · 2020: 1
FWCI
1.81
Type
journal article
Language
en
Open access
Licence
Locations
  • Cost Effectiveness and Resource Allocation (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • Tabriz University of Medical Sciences
  • University of Tabriz
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
catastrophic health expenditure, health care financing, financial protection, health equity, health insurance status, family financial burden, cancer, dialysis, health financing policy, Iran

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