Effective determinants in Household Out of Packet Payments in Health System of Iran, Using Two Part Regression Model

Major part of health expenditure is paid directly by households in most of developing countries. This catastrophic expenditure is entailed on families. Assessing important determinants of Out Of Pocket Payment (OOP) is one of the key issues in health care finance. This study uses Iranian household income expenditure in 2005-2010 annually provided by statistical center of Iran using a two part model for assessing these factors. This was a cross-sectional analytical study in which sampling was based on a multi-stage method. The sample size changed from 26882 to 38260 households. The results showed that out of Pocket payments up to 74% increased during this period. High income households paid 2.5 times more than low income groups while probability of utilization for them was 17% more. Confidence of insurance indicates insurance systems succeeded in reducing only 15% of household insure expenditure whereas the probability of using health services increased only by 2%. Social demographic variables such as the number of the elderly, household size and urbanization increased OOP by 20%, 23% and 54%, respectively. During the study period, there was substantial inequality among different income groups. As if better off households had a higher chance of paying and using health care services. Moreover, the elderly, household dimension, urbanization and not having insurance coverage are the most important factors responsible for OOP. To reduce inequality, policy makers must provide the conditions to increase the role of social insurance in health finance and to make the services less expensive for the elderly..