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Catastrophic Healthcare Expenditures Among Iranian Households: a Systematic Review and Meta-Analysis

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Catastrophic Healthcare Expenditures Among Iranian Households: a Systematic Review and Meta-Analysis See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/323604182 Catastrophic Healthcare Expenditures Among Iranian Households: A Systematic Review and Meta-Analysis Article · March 2018 DOI: 10.1108/IJHRH-02-2018-0017 CITATION READS 1 219 4 authors: Satar Rezaei Abraha Woldemichael Kermanshah University of Medical Sciences College of Health Sciences, Mekelle University, Mekelle, Ethiopia 240 PUBLICATIONS 4,948 CITATIONS 14 PUBLICATIONS 15 CITATIONS SEE PROFILE SEE PROFILE Mohammad Hajizadeh Ali Kazemi karyani Dalhousie University Kermanshah University of Medical Sciences 85 PUBLICATIONS 497 CITATIONS 53 PUBLICATIONS 142 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: socioeconomic inequality in cigarette expenditures in Iran View project Translate a useful book about Health Inequalities to Persian Language View project All content following this page was uploaded by Abraha Woldemichael on 20 August 2018. The user has requested enhancement of the downloaded file. International Journal of Human Rights in Healthcare Catastrophic healthcare expenditures among Iranian households: a systematic review and meta-analysis Satar Rezaei, Abraha Woldemichael, Mohammad Hajizadeh, Ali Kazemi Karyani, Article information: To cite this document: Satar Rezaei, Abraha Woldemichael, Mohammad Hajizadeh, Ali Kazemi Karyani, (2018) "Catastrophic healthcare expenditures among Iranian households: a systematic review and meta-analysis", International Journal of Human Rights in Healthcare, https://doi.org/10.1108/IJHRH-02-2018-0017 Permanent link to this document: https://doi.org/10.1108/IJHRH-02-2018-0017 Downloaded on: 20 August 2018, At: 06:58 (PT) References: this document contains references to 59 other documents. To copy this document: [email protected] Access to this document was granted through an Emerald subscription provided by Token:Eprints:JAGWSPDIYMVMTHFSP7ND: For Authors If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.com Emerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services. Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. *Related content and download information correct at time of download. Downloaded by TEHRAN UNIVERSITY OF MEDICAL SCIENCES At 06:58 20 August 2018 (PT) Catastrophic healthcare expenditures among Iranian households: a systematic review and meta-analysis Satar Rezaei, Abraha Woldemichael, Mohammad Hajizadeh and Ali Kazemi Karyani Abstract Satar Rezaei is based at the Purpose – Protecting households against financial risks of healthcare services is one of the main functions of Research Center for health systems. The purpose of this paper is to provide a pooled estimate of the prevalence of catastrophic Environmental Determinants of healthcare expenditures (CHE) among households in Iran. Health, Kermanshah University Design/methodology/approach – Both international (PubMed, Scopus and Clarivate Analytics (previously of Medical Sciences, known as the Institute for Scientific Information)) and Iranian (Scientific Information Database, Iranmedex and Kermanshah, Iran. Magiran) scientific databases were searched for published studies on CHE among Iranian households. Abraha Woldemichael is The following keywords in Persian and English language were used as keywords for the search: “catastrophic Lecturer at the School of Public healthcare costs,”“catastrophic health costs,”“impoverishment due to health costs,”“fair financial Health, College of Health contribution,”“prevalence,”“frequency” and “Iran” with and without “health system”. The I2-test and χ2-based Q-test suggested heterogeneity in the reported prevalence among the qualified studies; thus, a Sciences, Mekelle University, random-effects model was used to estimate the overall prevalence of CHE among households in Iran. Mekelle, Ethiopia. Findings – A total of 24 studies with a cumulative sample of 301,097 households were included in the study. Mohammad Hajizadeh is The estimated pooled prevalence of CHE among households was 7 percent (95 percent confidence interval: Assistant Professor at the 6–8 percent). Meta-regression analysis indicated that the prevalence of CHE was inversely related to the School of Health sample size (po0.05). The results did not suggest a significant association between the prevalence of CHE Administration, Faculty of and the year of data collection. Health, Dalhousie University, – Originality/value The findings revealed that the prevalence of CHE among Iranian households is Halifax, Canada. significantly higher than 1 percent, which is the goal set out in Iran’s fourth five-year development plan. Ali Kazemi Karyani is based at This warrants further policy interventions to protect households from incurring CHE in Iran. the Research Center for Keywords Faith, Human rights, Healthcare, Public services Environmental Determinants of Paper type Literature review Health, Kermanshah University of Medical Sciences, Kermanshah, Iran. Introduction Protecting households against financial risks of healthcare services is one of the main functions of health systems (World Health Organization, 2000). The universal health coverage (UHC) strives to Downloaded by TEHRAN UNIVERSITY OF MEDICAL SCIENCES At 06:58 20 August 2018 (PT) ensure financially accessible essential healthcare services to all population groups, regardless of their socioeconomic differences. That is, people should not experience financial hardship in receiving the essential healthcare services. Thus, financial protection is considered as one of the Received 11 February 2018 most important indicators for evaluating whether a country has achieved the UHC (World Health Revised 2 March 2018 Organization, 2010). Nevertheless, the out-of-pocket payments (OOP) is one of the main sources Accepted 6 March 2018 The authors gratefully of healthcare financing in under-resourced countries (Saito et al., 2014). For example, the OOP in acknowledge the research council Iran is estimated to be more than 40 percent (World Health Organization, 2000). Available evidence of Kermanshah University of shows a strong correlation between higher levels of OOP and the incidence of catastrophic Medical Sciences for providing financial support. This study was healthcare expenditures (CHE) and impoverishing health expenditures (Xu et al.,2003). extracted from an approved project by Kermanshah University Several studies have documented the levels of CHE in different countries. In a study conducted in of Medical Sciences (KUMS) and 89 countries (Xu et al., 2007), the level of CHE was reported 3 percent in low-income countries, was funded and supported by the Research Deputy of KUMS (Grant 1.8 percent in middle-income countries and 0.6 percent in high-income countries. No. 96419). DOI 10.1108/IJHRH-02-2018-0017 © Emerald Publishing Limited, ISSN 2056-4902 j INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE The prevalence of CHE varies across Asian and African countries. While about 4.1 percent of households experience CHE in South Korea (Choi et al., 2016), 13 percent of households face CHE in China (Li et al., 2012). The rate of CHE was 6–15 and 2.9 percent in Burkina Faso and Uganda, respectively (Su et al., 2006; Xu et al., 2006). According to the World Health Organization (WHO), CHE occurs when a household pays more than 40 percent of its capacity to pay for healthcare services. The capacity to pay is defined as total income minus spending on essential items such as food (World Health Organization, 2000). Approximately 44m households (over 150m people) experience CHE globally every year from healthcare services use. Some poor households even decide not to use healthcare services due to lack of protection from financial risks associated with healthcare expenses. In fact, financial protection of households against healthcare expenditures is one of the main concerns of policy makers (World Health Organization, 2005). Healthcare services in Iran are provided by three sectors, namely public, private and not for profit. Public sector mainly delivers all the three levels of healthcare (i.e. primary, secondary and tertiary) in rural and urban areas. The private sector provides secondary and tertiary healthcare in urban areas only. Non-governmental organizations are active in providing health services for chronic (e.g. diabetes) and severe patients such as cancer patients. Healthcare in Iran is funded through the government’s general revenue (primary raised from general tax revenue and sale of natural resources), health insurance organizations and individual OOP (Mehrdad, 2009; Hajizadeh and Connelly, 2010). In Iran, the high OOP and poor financial protection of households against CHE are among the major public health concerns. Thus, the recent economic, social and cultural development plan ( fourth five-year development
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