Impoverishing Health Expenditure in Iran Before and After the COVID-19 Pandemic: A National Cross-sectional Study
-
Ali Darvishi
,
Vahid Yazdi-Feyzabadi
,
Mina Bahrampour
,
Mohsen Bayati
,
Mohammad Hossein Mehrolhassani
,
Mohammadreza Sheikhy-Chaman
Abstract
Background: The COVID-19 pandemic has altered healthcare service utilization patterns and, consequently, the financial protection indicators.
Objectives: This study aims to examine the impoverishment caused by health expenditures before and during the COVID-19 pandemic in Iran.
Methods: This retrospective-descriptive study was conducted using six years of national income and expenditure data (2016 - 2021) from 228,910 households. We measured the occurrence and intensity indices of impoverishing health expenditure, such as the poverty headcount (PH), normalized poverty gap (NPG), and normalized mean positive poverty gap (NMPG), at the rural and urban levels separately.
Results:The PH increased from 2016 to 2018, decreased in 2019, and rose again in 2020 and 2021. Moreover, the occurrence of impoverishment health expenditure was at its lowest level in 2016 compared to previous years. PH was consistently higher in rural areas. NPG increased from 2016 to 2018, decreased in 2019, and increased again in 2020 and 2021. The NMPG index ranged from 0.11% to 0.62% in rural areas, and from 0.34% to 1.18% in urban areas.
Conclusion: Impoverishing health expenditure in Iran was significant, especially for rural residents. The COVID-19 pandemic did not change this trend. Reforming economic policies and providing targeted financial support for vulnerable populations are crucial.
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11. Maher A, Fazel Z. Assessing the catastrophic health expenditure and impoverishment in Iran in 2012 and 2015 (before and after the implementation of HTP in Iran). J Health Econom Dev. 2019;1(2):22-33.
12. Rezaei S, Woldemichael A, Hajizadeh M, Kazemi Karyani A. Catastrophic healthcare expenditures among Iranian households: a systematic review and meta-analysis. Int J Hum Rights Healthcare. 2019;12(2):105-15. https://doi.org/10.1108/ijhrh-02-2018-0017.
13. Yazdi-Feyzabadi V, Mehrolhassani MH, Darvishi A. Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program. Health Policy Plan. 2019;34(4):316-25. [PubMed ID:31157361]. https://doi.org/10.1093/heapol/czz031.
14. Mirzaei A, Joshani-Kheibari M, Esmaeili R. Comparison of the Distribution of Household Financial Contributions to the Health System before and during COVID-19 Outbreak: Evidence from Nationwide Survey in Iran. Med J Islam Repub Iran. 2023;37:11. [PubMed ID:37123341]. [PubMed Central ID:PMC10134080]. https://doi.org/10.47176/mjiri.37.11.
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17. Shokri A, Bolbanabad AM, Rezaei S, Moradi G, Piroozi B. Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey.
Health Sci Rep. 2023;6(4):e1199. [PubMed ID:37064323]. [PubMed Central ID:PMC10102736]. https://doi.org/10.1002/hsr2.1199.
18. Moradi M, Appolloni A, Zimon G, Tarighi H, Kamali M. Macroeconomic Factors and Stock Price Crash Risk: Do Managers Withhold Bad News in the Crisis-Ridden Iran Market? Sustainability. 2021;13(7). https://doi.org/10.3390/su13073688.
19. Hadian M, Harati-Khalilabad T, Sheikhy-Chaman M. [Controlling the costs of the Iranian health system]. Tehran Univ Med J TUMS Publications. 2021;79(4):324-5. Persian.
20. Statistical Center of Iran. [Household, Expenditure and Income: Definitions, concepts and statistical survey]. 2024. Persian. Available from: https://amar.org.ir/cost-and-income.
21. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003;362(9378):111-7. [PubMed ID:12867110]. https://doi. org/10.1016/S0140-6736(03)13861-5.
22. World Bank. PPP conversion factor, GDP (LCU per international $) - Iran, Islamic Rep. 2024. Available from: https://data.worldbank.org/ indicator/PA.NUS.PPP?locations=IR.
23. Darvishi A, Amini-Rarani M, Mehrolhassani MH, Yazdi-Feyzabadi V. Fairness in household financial contribution to the Iran’s healthcare system from 2008 to 2018. BMC Res Notes. 2021;14(1):190. [PubMed ID:34001249]. [PubMed Central ID:PMC8130119]. https://doi.org/10.1186/s13104-021-05606-8.
24. Yazdi Feyzabadi V, Mehrolhassani MH, Haghdoost AA, Bahrampour M. [The Trend of Impoverishing Effects of Out-Of-Pocket Health Expenditure in Iranian Provinces in 2008-2014]. Iran J Epidemiol. 2017;12(0):20-31. Persian.
25. Khammarnia M, Barfar E, Ansari-Moghadam A, Setoodehzadeh F, Zanganeh Baygi M, Peyvand M, et al. The Households Health Spending and Impoverishment: A Study After Iran’s Health Transformation Plan. Health Scope. 2018;7(S). https://doi.org/10.5812/jhealthscope.62316.
26. Abdi Z, Hsu J, Ahmadnezhad E, Majdzadeh R, Harirchi I. An analysis of financial protection before and after the Iranian Health Transformation Plan. East Mediterr Health J. 2020;26(9):1025-33. [PubMed ID:33047793]. https://doi.org/10.26719/emhj.19.026.
27. Amiresmaili M, Emrani Z. Studying the impoverishing effects of procuring medicines: a national study. BMC Int Health Hum Rights. 2019;19(1):23. [PubMed ID:31366400]. [PubMed Central ID:PMC6670235]. https://doi.org/10.1186/s12914-019-0210-x.
28. Mulaga AN, Kamndaya MS, Masangwi SJ. Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi. PLoS One. 2021;16(3):e0248752. [PubMed ID:33788900]. [PubMed Central ID:PMC8011740]. https://doi.org/10.1371/journal.pone.0248752.
29. Zhao Y, Oldenburg B, Mahal A, Lin Y, Tang S, Liu X. Trends and socio-economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016. Trop Med Int Health.
2020;25(2):236-47. [PubMed ID:31713972]. https://doi.org/10.1111/tmi.13344.
30. Wagstaff A, Flores G, Smitz MF, Hsu J, Chepynoga K, Eozenou P. Progress on impoverishing health spending in 122 countries: a retrospective observational study. Lancet Glob Health. 2018;6(2):e180-
e92. [PubMed ID:29248366]. https://doi.org/10.1016/S2214-109X(17)30486-2.
31. Akazili J, Ataguba JE, Kanmiki EW, Gyapong J, Sankoh O, Oduro A, et al. Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana. BMC Int Health Hum Rights. 2017;17(1):13. [PubMed ID:28532403]. [PubMed Central ID:PMC5440955]. https://doi.org/10.1186/s12914-017-0121-7.
32. Fu W, Shi J, Zhang X, Liu C, Sun C, Du Y, et al. Effects of cancer treatment on household impoverishment: a multicentre cross-sectional
study in China. BMJ Open. 2021;11(6):e044322. [PubMed ID:34193481].[PubMed Central ID:PMC8246348]. https://doi.org/10.1136/bmjopen-2020-044322.
33. Chuma J, Maina T. Catastrophic health care spending and impoverishment in Kenya. BMC Health Serv Res. 2012;12:413. [PubMed ID:23170770]. [PubMed Central ID:PMC3561146]. https://doi.org/10.1186/1472-6963-12-413.
34. Kwesiga B, Zikusooka CM, Ataguba JE. Assessing catastrophic and impoverishing effects of health care payments in Uganda. BMC Health Serv Res. 2015;15:30. [PubMed ID:25608482]. [PubMed Central ID:PMC4310024]. https://doi.org/10.1186/s12913-015-0682-x.
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| Files | ||
| Issue | Vol 9 No 3 (2025) | |
| Section | Articles | |
| Keywords | ||
| Out-of-pocket (OOP) payments Impoverishment health expenditure COVID-19 Health equity Iran | ||
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How to Cite
1.
Darvishi A, Yazdi-Feyzabadi V, Bahrampour M, Bayati M, Mehrolhassani MH, Sheikhy-Chaman M. Impoverishing Health Expenditure in Iran Before and After the COVID-19 Pandemic: A National Cross-sectional Study. Health Tech Ass Act. 2025;9(3).
