health expenditure

Breast cancer (BC) is the most common type of cancer among Iranian women. The cost of breast cancer treatment is high, and many families struggle to afford it.

This study was conducted with the aim of determining the out-of-pocket (OOP) health expenditure and factors affecting it in BC patients in Shahid Jalil Hospital affiliated to Yasuj University of Medical Sciences, Iran.

This study was conducted in a cross-sectional descriptive-analytical way. Based on the inclusion criteria, the health expenditure of 82 patients with BC were collected. The data was gathered from Shahid Jalil Hospital, affiliated with Yasuj University of Medical Sciences. It includes inpatient and outpatient information from the Iran Health Insurance Organization, as well as patient-declared costs in 2022. The study data analyzed using descriptive statistics methods including frequency, percentage, mean and standard deviation, and stepwise linear regression to investigate the effect of variables on the amount of OOP health expenditure in SPSS 21 software.

The OOP expenses for BC patients accounted for 32.89% of the total direct medical expenses. Of the OOP costs, 47.18% were attributed to drug expenses, 16.19% to laboratory costs, 11.74% to imaging expenses, 11.20% to visit costs, 8.40% to hospitalization expenses, 2.84% to doctor’s services, and 2.45% to physical therapy-related expenses. Factors such as age, place of residence, occupation, education, and household income were among the factors that had a significant effect on OOP payments (P < 0.05). Marital status, housing situation, and social coverage had no significant effect on patients' OOP payments (P > 0.05).

BC patients incur a lot of expenses, and about 32.89% of these expenses are OOP payments. It is essential for insurance organizations to increase their coverage, while also requiring additional support from the government for patients with breast cancer in obtaining necessary medication and medical supplies.

Health expenditures of countries have an increasing trend in general and identifying variables affecting health expenditure is an important step toward budget planning for financial sustainability. This study aimed to examine the health expenditure of the Organisation for Economic Co-operation and Development (OECD) countries and identify influential variables.

The data for the years 2000-2018 of OECD countries’ current health expenditure (% of GDP) and economic, demographic, and health variables, considered to affect the health expenditure, to include in the anal-ysis were extracted using the World Bank database (World Bank 2021). Data analys using Chi-Squared Automatic Interaction Detection (CHAID) decision tree technique. Fifteen variables in economic, demographic, and health categories are selected to build the CHAID decision tree.

As a result of CHAID analysis, five variables are identified as influential on current health expenditure, which are gross domestic product per capita, life expectancy at birth, death rate, out-of-pocket expenditure, and fertility rate. Thirty-seven OECD countries are classified into eleven groups by the decision rules in terms of the current health expenditure. The high value of the correlation coefficient between the predicted values and the actual values of health expenditure of countries indicates good prediction performance. Moreover, the regression models built using the identified influential variables as explanatory variables give good forecast accuracy.

As an effective tool, the CHAID decision tree technique provides a rule-based model in the form of a tree with nodes and branches, illustrating the splitting process graphically with identified variables and their cut-off points for classification and prediction.

Progressive realization of universal health coverage (UHC) requires health systems capacity to provide quality service and financial risk protection which supports access to services without financial hardship. Government health spending in low-income countries (LICs) has been low and heavily relied on external donor resources and out-ofpocket payment. This has resulted in high prevalence of catastrophic health spending or foregone care by those who cannot afford. Under fiscal constraints posed by pandemic, reforms in LICs should focus on efficiency through health resource waste reduction. Targeting the poor even with low level of health spending can make a significant health gain. Investment in primary healthcare and health workforce is the foundation for realizing UHC which cannot be postponed. Innovative tax on health hazardous products, conditional debt relief can increase fiscal space for health; while international collaboration to accelerate coronavirus disease 2019 (COVID-19) vaccine coverage can bring LICs out of acute phase of pandemic.

Families are willing to spend their entire lives improving their children due to emotional attachments, which, in turn, increases their exposure to catastrophic health expenditures (CHEs). The present study aimed to estimate the level of exposure to CHEs and its determinants among households with pediatric cancer and oncology disorders.

This cross-sectional study was performed on 101 households with pediatric cancer and oncology patients who referred to Shahid Sadoughi Hospital of Yazd in 2021. The CHE in this regard was defined as the out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay. The data on each household were collected with reference to the patient's electronic file and through a questionnaire completed during an interview with the head of the household. The data were also analyzed with descriptive statistics and logistic regression in Excel (2019) and STATA ver.15.

Out of 101 households in the study, 43 (42.6%) incurred CHEs (based on a threshold of 40% of disposable income). Regarding the job of the heads of households, manual workers were vulnerable to CHEs up to 11.7 times more than employees and self-employed individuals (OR=11.7, p<0.05). Also, the lower the education level of the head of the household, the higher the risk of facing CHEs (OR=10.45, p<0.05). Similarly, the lower his or her income, the higher the CHE.

The results showed that households with pediatric cancer and oncology disorders were significantly exposed to CHEs. Due to the limited resources of the health system in the treatment of cancer patients and the need for expenditure control programs, it seems better to focus on cost control strategies for this group of patients.

Stroke is one of the leading public health issues in China and imposes a heavy financial burden on patients and the healthcare system. This study assess which payment method provides the lowest hospital costs for China’s healthcare system and the lowest out-of-pocket (OOP) expense for insured patients.

This is a 4-year cross-sectional study. From the China Health Insurance Research Association (CHIRA) database, a 5% random sample of urban health insurance claims was obtained. Descriptive analysis was conducted and a generalized linear model (GLM) with a gamma distribution and a log link was estimated.

For outpatients, capitation payment had the lowest hospital cost (RMB180.9/US$28.8) and lowest OOP expenses (RMB75.6/US$12.0) per patient visit in primary hospitals compared with fee-for-service (FFS) payments. The global budget (GB) displayed the lowest total hospital costs (RMB344.7/US$54.8) in secondary hospitals, and was 27.4% (95% CI=-0.32, -0.29) lower than FFS. FFS had the lowest OOP expenses (RMB123.4/US$19.6 vs. RMB151.8/US$24.1) in secondary and tertiary hospitals. For inpatients, FFS had the lowest total hospital costs (RMB5918.7/US$941.1) per visit and capitation payments had the lowest OOP expenses (RMB876.5/US$139.4, 40.1% lower than FFS, 95% CI=-0.58, -0.15) in primary hospitals. Capitation payment had both the lowest hospital costs (RMB7342.9/US$1167.5 vs. RMB17 711.7/US$2816.2) and the lowest OOP expenses (RMB1664.2/US$264.6 vs. RMB3276.3/US$520.9) for both secondary and tertiary hospitals.

For outpatients in primary hospitals and inpatients in secondary and tertiary hospitals, the capitation payment was the most money-saving payment method delivering both the lowest OOP expenses for patients and the lowest hospital total costs for hospitals. We recommend that health policymakers prioritize the implementation of the payment method with the lowest OOP expenses when the payment method does not deliver both the lowest hospital costs for the health system and lowest OOP expenses for patients.

The projection of levels and composition of financial resources for the healthcare expenditure (HCE) and relevant trends can provide a basis for future health financing reforms. This study aimed to project Iran’s HCEs by the sources of funds until 2030.

The structural macro-econometric modeling in the EViews 9 software was employed to simulate and project Iran’s HCE by the sources of funds (government health expenditure [GHCE], social security organization health expenditure [SOHCE], out-of-pocket [OOP] payments, and prepaid private health expenditure [PPHCE]). The behavioral equations were estimated by autoregressive distributed lag (ARDL) approach.

If there is a 5%-increase in Iran’s oil revenues, the mean growth rate of gross domestic product (GDP) is about 2% until 2030. By this scenario, the total HCE (THCE), GHCE, SOHCE, OOP, and PPHCE increases about 30.5%, 25.9%, 34.4%, 31.2%, and 33.9%, respectively. Therefore, the THCE as a percentage of the GDP will increase from 9.6% in 2016 to 10.7% in 2030. It is predicted that Iran’s THCE will cover 22.2%, 23.3%, 40%, and 14.5% by the government, social security organization (SSO), households OOP, and other private sources, respectively, in 2030.

Until 2030, Iran’s health expenditures will grow faster than the GDP, government revenues, and non-health spending. Despite the increase in GHCE and total government expenditure, the share of the GHCE from THCE has a decreasing trend. OOP payments remain among the major sources of financing for Iran’s HCE.

This study aimed to systematically review the literature on the Iranian healthcare system in the time of increasing privatization.

A systematic literature review was conducted using MEDLINE, CINAHL, APA PschInfo, and Cochrane databases to identify various concepts in the literature concerning the privatization of healthcare in Iran between September and November 2020. All the included articles were assessed using the John Hopkins Nursing Evidence-Based Practice Research tool. In addition, grey literature was searched using Google targeted at academic websites and key organizations and online newspapers and magazines in the Persian language. This screening resulted in a total of 70 articles, reports, and documents. The PRISMA guidelines were followed for abstracting data and assessing the quality of the studies.

Six health-related items were identified at the time of increased privatization in the healthcare system. These items consisted of medical establishments, accessibility, and privatization, catastrophic health expenditure (CHE), out-of-pocket payment (OOP), health inequality, privatization, and healthcare providers, and the policy and finance of privatization.

The review identified that the process of privatization of the healthcare system in Iran occurred with poor monitoring and evaluation mechanisms. Privatization rested on neoliberal arguments, and for-profit care has worsened healthcare performance and created an unfair, expensive healthcare system of lower quality in Iran.

The COVID‑19 pandemic has spread rapidly across the world and has currently impacted most countries and territories globally. This study aimed to identify health‑care determinants of mortality and recovery rates of COVID‑19 and compare the efficiency of health systems in response to this pandemic.

A cross‑sectional study was conducted using data obtained from the World Bank database, that provides free and open access to a comprehensive set of health‑ and socioeconomic‑related data, by September 12, 2020. An adjusted linear regression model was applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1 MP) in the included countries. One‑way analysis of variance was applied to assess health systems’ efficiency in response to COVID‑19 pandemic using mortality and recovery rate (output variables) and current health expenditure (CHE) per capita (input variable).

Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1 MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and population aged 65 years and over as a percentage of total population (SC = −0.79, P < 0.001) significantly predicted recovered cases from COVID‑19 in the included countries.

This study revealed that countries with higher CHE per capita and higher proportion of older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore, our study indicated that health systems with higher CHE per capita statistically had a greater efficiency in response to COVID‑19 compared to those with lower CHE per capita. More attention to preventive strategies, early detection, and early intervention is suggested to improve the health system efficiency in controlling COVID‑19 and its related mortalities worldwide.

The health sector directly contributes to economic growth and paves the way for the development of other economic sectors. This study investigates the short-term and long-term effects of health expenditure shocks and real exchange rate fluctuations, as well as the symmetry and asymmetry of these shocks on the logarithm of value-added of the health sector in the Iranian economy.

The data related to the research variables were extracted from the website of the Central Bank of Iran (CBI) and the website of the World Bank. Using Eviews software (version 9) and applying the Hodrick-Prescott (HP) filter, health expenditure and real exchange rates were assessed as predictable and unpredictable shocks. Then, unpredictable shocks were decomposed into positive and negative components. In the next step, shocks were specified on the logarithm of value-added in the health sector along with control variables for the time period of 1973 to 2014.

Estimation of asymmetric health expenditure model and real exchange rate for the logarithm of value added of the health sector indicated different effects of health expenditure shocks in the short run and the symmetry of these shocks in the long run. But the effect of real exchange rate shocks on the logarithm of value added in the health sector in the short run and the persistence of these shocks in the long run were asymmetric and significant.

The effectiveness of health expenditure shocks on value added of the health sector in the short run is the basis for the growth of the country's macroeconomy and the effectiveness of real exchange rate shocks on the Iranian health sector, both in the short and long run, marks this variable as an important factor in the economic policies of the health sector.

Inappropriate and irrational use of numerous advanced diagnostic imaging technologies has recently been highlighted in many countries and has gathered the attention of policymakers. This matter has not only increased health costs in countries but also resulted in adverse health results. Various factors are involved in the inappropriate or unnecessary use of advanced medical imaging techniques including patient‑related, physician‑related, technological, and ultimately radiologist‑related factors. This calls for the provision of new guidelines by policymakers to encourage all service providers to make appropriate use of such techniques. One of the main approaches in this regard is the application of clinical guidelines and decision support systems. The present study was a systematized review that conducted in January 2019, and the articles related to palliative care requirements on databases of Web of Science, PubMed, Scopus, ScienceDirect, Ovid, ProQuest, Wiley, and Google Scholar from January 1, 2009, to January 20, 2019, were searched. Strategy for searching and selecting the articles was Preferred Reporting Items for Systematic Reviews and Meta‑Analyses Guidelines. Overview of the studies shows that various reasons for the overuse of diagnostic imaging technologies and effects of applying clinical guidelines on reducing diagnostic costs of treatment are investigated in this article with respect to various aspects and viewpoints. Clinical guidelines can be significantly effective in evaluating suitability and quality of referrals for diagnostic imaging, if only adapted properly.

Human capital is an effective variable on the health condition of a society and its changing changes health expenditure as the proxy of health. This study aimed to investigate the relationship between human capital determinants and health expenditure.

An empirical model was used with 7 variables included gender parity (GPI) index, literacy rate, life expectancy at birth, GDP per capita, physician per capita, and hospital’s bed as the independent variable and health expenditure as depended variable. After unit root test of data by using Zivot-Andrews method, the model was estimated by ordinary least square (OLS) method.

GPI had the negative and significant impact on health expenditure. Literacy had the positive and significant impact on depended variable. In addition, GDP per capita and life expectancy had positive and significant on health expenditure. Hospital bed and physician per capita did not have the significant relationship with health expenditure.  The value of R-squared and Durbin-Watson statistic were 0.99 and 1.95 respectively, which showed good model fit.

literacy rate and GPI index as the proxy of human capital had the different impact on health expenditure. The first had positive and the latter had negative. GDP per capita had the positive impact that showed health was a normal good.

Recently, inequality in dental care has become increasingly popular in both developed and developing countries as a matter of health policy. Thus, the aims of this study were examining inequality in dental care expenditures and assessing the effects of insurance coverage and other variables on these services.

In this cross‑sectional and descriptive‑analytical study, we used secondary data of the National Health Accounts that has been conducted in 2008 in Iran. The sample size was 17,239 households in all over the country. All analyses were performed by Stata software using Mann–Whitney test and logistic regression. P < 0.05 was considered statistically significant. To determine inequality in dental services, the concentration index (CI) was used.

CI for total dental expenditures was 0.315 and for orthodontics was 0.6. Findings showed that out‑of‑pocket expenditure for dental care was progressive and there was a significant relationship between total dental expenditure with residence areas (odds ratio [OR] =1.3; P > 0.001), complementary insurance coverage (OR = 1.3; P > 0.001), family size (OR = 1.46; P > 0.001), and income (OR = 1.3; P > 0.001).

Dental expenditures were progressive in Iran, and the rich have paid more share for these services. It seems that implementing insurance programs, changes in the financing of dental care, development of insurance basic benefits package, supporting programs for the poor, adopting educational policies, and promoting oral health for vulnerable people can have an effective role in decreasing inequality in using dental services.

To describe the utilization and out-of-pocket (OOP) payments of war survivors receiving health care services and its determinants.

A cross-sectional study was carried out by systematic random sampling at national level (n = 3079) on healthcare utilization in war survivors on their last received services. A validated questionnaire was used to gather the information of inpatient and outpatient healthcare services and OOP payment. The data were analyzed to indicate the determinants of health utilization and expenses.

Health care utilization was reported in 91.6% (n = 2822). The majority (82.5%) received one or two services in their last visits, mostly related to physician visits and medications (65.97%). Health care utilization was higher than general population annually, especially in physician visit (6.6 versus 4.89), medication (5.1 versus 3.6), and hospitalization (0.78 versus 0.15). About 20.2% (n = 599) of the study population paid out of their pocket for their last medical care services. The frequency of OOP payment was greater for physician visit and medication. Payment for hospitalization, imaging, and lab tests were more significantly associated with proceeding to reimburse the expenses (P < 0.001). The median OOP payment was US$10.8 (interquartile range US$20.6). Gender (P = 0.003), area of residence (P = 0.01) and being war victims (P = 0.005) were the significant determinants for both OOP payments and reclaiming the expenditure. Higher amount of payments (P < 0.001) and more received health services (P = 0.002) were also important factors in reclaiming the expenditure.

Both outpatient services and hospital admission are more frequent among war survivors compared to the general Iranian population. Future studies should attempt to explore the reasons.