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Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households
Ehsan Aghapour, Mehdi Basakha, Seyed Hossein Mohaqeqi Kamal, Abolghasem Pourreza
J Prev Med Public Health. 2022;55(4):379-388.   Published online June 27, 2022
DOI: https://doi.org/10.3961/jpmph.22.123
  • 2,487 View
  • 80 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.
Methods
This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.
Results
Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.
Conclusions
In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.
Summary

Citations

Citations to this article as recorded by  
  • Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics
    Neda Soleimanvandiazar, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, Salah Eddin Karimi, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Ameneh Setareh Forouzan
    INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2024;[Epub]     CrossRef
Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change
Tae-Jin Lee, Chelim Cheong
J Prev Med Public Health. 2017;50(6):393-400.   Published online November 9, 2017
DOI: https://doi.org/10.3961/jpmph.17.151
  • 8,936 View
  • 165 Download
  • 5 Crossref
AbstractAbstract PDF
Objectives
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups.
Methods
This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics.
Results
The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients.
Conclusions
The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
Summary

Citations

Citations to this article as recorded by  
  • Network analysis of stroke systems of care in Korea
    Jihoon Kang, Hyunjoo Song, Seong Eun Kim, Jun Yup Kim, Hong-Kyun Park, Yong-Jin Cho, Kyung Bok Lee, Juneyoung Lee, Ji Sung Lee, Ah Rum Choi, Mi Yeon Kang, Philip B Gorelick, Hee-Joon Bae
    BMJ Neurology Open.2024; 6(1): e000578.     CrossRef
  • Has South Korea achieved the goals of national health insurance? Trends in financial protection of households between 2011 and 2018
    Sujin Kim, Soonman Kwon
    Social Science & Medicine.2023; 326: 115929.     CrossRef
  • Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data
    Dong‐Woo Choi, Sun Jung Kim, Seungju Kim, Dong Wook Kim, Wonjeong Jeong, Kyu‐Tae Han
    Cancer Medicine.2023; 12(13): 14707.     CrossRef
  • Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China
    Zhenyu Shi, Ping He, Dawei Zhu, Feng Lu, Qingyue Meng
    BMC Health Services Research.2022;[Epub]     CrossRef
  • News media’s framing of health policy and its implications for government communication: A text mining analysis of news coverage on a policy to expand health insurance coverage in South Korea
    Wonkwang Jo, Myoungsoon You
    Health Policy.2019; 123(11): 1116.     CrossRef

JPMPH : Journal of Preventive Medicine and Public Health