The Place of Health Insurance in Reducing Catastrophic Health Expenditure

Document Type: Research Paper

Authors

1 Independent Researcher

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

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

Abstract

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.

Keywords


References

 Basar, D., Brown, S., & Hole, A. R. (2012). Out-of-pocket health care expenditure in Turkey: Analysis of the household budget surveys 2002-2008.

Cavagnero, E., Carrin, G., Xu, K., & Aguilar-Rivera, A. M. (2006). Health financing in Argentina: An empirical study of health care expenditure and utilization. Innovations in Health Financing: Working Paper Series8.

Ekman, B. (2007). Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country. Health policy83(2-3), 304-313. Doi: 10.1016/j.healthpol.2007.02.004

Fazaeli, A. A., Ghaderi, H., Fazaeli, A. A., Lotfi, F., Salehi, M., & Mehrara, M. (2015). Main determinants of catastrophic health expenditures: A Bayesian Logit approach on Iranian household survey data (2010). Global Journal of Health Science7(4), 335-340. Doi: 10.5539/gjhs.v7n4p335

Ghiasvand, H., Hadian, M., Maleki, M. R., & Shabaninejad, H. (2010). Determinants of catastrophic medical payments in hospitals affiliated to Iran University of Medical Sciences 2009. Hakim Research Journal13(3), 145-154. Doi: 0141707/AIM.0012

Ghiasvand, H., Sha’baninejad, H., Arab, M., & Rashidian, A. (2014). Hospitalization and catastrophic medical payment: Evidence from hospitals located in Tehran. Archives of Iranian Medicine17(7), 507-513. Doi: 0141707/AIM.0012

Harris, C. R., & Jenkins, M. (2006). Gender differences in risk assessment: Why do women take fewer risks than men? Judgment and Decision Making1(1), 48-63.

Hatam, N., Orejlu, P. H., Jafari, A., & Kavosi, Z. (2015). Catastrophic healthcare expenditures of hospitalized patients in the hospitals of Shiraz in 2013. Shiraz E-Medical Journal16(5). e22231.

Li, Y., Wu, Q., Xu, L., Legge, D., Hao, Y., Gao, L., Ning, N.  & Wan, G. (2012). Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: Policy implications of universal health insurance. Bulletin of the World Health Organization90, 664-671. Doi: 10.2471/BLT.12.102178

Mahboobi-Ardakan, P., Mehraban, S., & Kazemian, M. (2016). Estimation of total consumption function of health care services in Iran from 1981 to 2011. Journal of Management and Training for Industries3(2), 30-40.

Mehrara, M., & Fazaeli, A. A. (2010). Health finance equity in Iran: An Analysis of household survey data (1382-1386). Journal of Health Administration13(40), 51-62.

Mehrdad, R. (2009). Health system in Iran. JMAJ52(1), 69-73.

Roberts, M., Hsiao, W., Berman, P., & Reich, M. (2003). Getting Health Reform Right: A Guide to Improving Performance and Equity. Oxford: Oxford University Press.

Sinha, R. K., Chatterjee, K., Nair, N., & Tripathy, P. K. (2016). Determinants of out-of-pocket and catastrophic health expenditure: A cross-sectional study. British Journal of Medicine and Medical Research11(8), 1-11.

Therapeutic deputy of Ministry of Health and Medical Education (2011). General Tariffs for Diagnostic and Therapeutic Services in Public and Private Sector at 2011. Tehran: Rahavard.

Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. (2003). Household catastrophic health expenditure: A multicountry analysis. The Lancet362(9378), 111-117.

Xu, K., Evans, D. B., Kadama, P., Nabyonga, J., Ogwal, P. O., Nabukhonzo, P., & Aguilar, A. M. (2006). Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda. Social science & Medicine62(4), 866-876. Doi: 10.1016/j.socscimed.2005.07.004

Yardim, M. S., Cilingiroglu, N., & Yardim, N. (2013). Financial protection in health in Turkey: The effects of the health transformation programme. Health policy and Planning29(2), 177-192.