The Place of Health Insurance in Reducing Catastrophic Health Expenditure

Document Type: Research Paper


1 Independent Researcher

2 Faculty of Social Sciences & Economics, Alzahra University, Tehran, Iran.

3 Faculty of Social Sciences & Economics, Alzahra University, Tehran, 1993891176, Iran.


This paper was aimed to investigate the mixed empirical results on the effect of health insurance in reducing the risk of catastrophic health expenditure (CHE). We investigated a wide range of factors affecting the risk of CHE among patients admitted to hospitals in Tehran. We categorized hospitals into five groups from private hospitals to charity ones. The data used herein was extracted from the second round of Urban Health Equity Assessment and Response Tool. Determinants of CHE were identified using logistic regression. We found that the significant effect of insurance on aggregate data was solely determined by its effect on reducing the risk of CHE in social security organization hospitals. Insured people by this organization allocate a higher proportion of their salaries to the health insurance and are admitted to the organizational hospitals free of charge. This finding shows the bias inherited in the aggregation and provides support for full pre-payments mechanisms. Our findings suggest that individuals relate CHE to the chosen hospitals, which, in turn, needs to be based on individuals’ health insurance and socio-economic conditions.


Article Title [Persian]

چه زمانی بیمه درمان در کاهش هزینه کمرشکن سلامت موثر است؟

Authors [Persian]

  • ستار مهربان 1
  • نرگس حاجی ملا درویش 2
  • حسین راغفر 3
2 دانشکده علوم اجتماعی و اقتصاد دانشگاه الزهرا
Abstract [Persian]

هدف این مقاله بررسی نتایج تجربی متناقض در رابطه با اثر بیمه درمانی در کاهش خطر ابتلا به هزینه کمرشکن سلامت است. طیف گسترده ای از عوامل موثر بر ریسک ابتلا به هزینه کمرشکن سلامت در بیماران بستری شده در بیمارستان های تهران بررسی شده است. ما بیمارستان ها را به پنج گروه از بیمارستان‌های خصوصی تا بیمارستان‌های خیریه تقسیم کردیم. داده های استفاده شده در این مقاله ازمرحله دوم طرح سنجش عدالت در سلامت شهر تهران استخراج شده است. عوامل تعیین کننده هزینه کمرشکن سلامت با استفاده از رگرسیون لجیت مشخص شدند.
نتایج ما نشان می دهد که تأثیر قابل توجه بیمه سلامت در داده های جمع آوری شده منحصر به تأثیر آن در کاهش هزینه کمرشکن سلامت در بیمارستان‌های سازمان تأمین اجتماعی است. بیمه شدگان این سازمان، نسبت بیشتری از حقوق و دستمزد خود را برای بیمه درمان می‌پردازند و در بیمارستانهای سازمانی به صورت رایگان پذیرش می‌شوند. این نتیجه، سوگیری ذاتی در جمع پذیری را نشان می دهد و از ساز و کارهای پیش پرداخت حمایت می‌کند. یافته های ما نشان می‌دهد که هزینه کمرشکن سلامت به بیمارستان های انتخاب شده توسط افراد بستگی دارد و این بیمارستانها باید متناسب با پوشش بیمه های درمانی افراد و شرایط اجتماعی-اقتصادی آنها انتخاب شوند.

Keywords [Persian]

  • هزینه کمرشکن سلامت
  • بیمه درمان
  • انواع بیمارستان ها

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