The Impact of medical Insurances on out-of-pocket payments among urban households in Iran:A Double-Sample selection Model

Health insurance is one of the most important components of health care financing to reduce inequality in out-of-pocket payments. Therefore, considering the importance of insurance, increased out-of-pocket payment, and the demand for private insurance, and also the multiplicity of insurance funds, this study aimed to investigate the effects of health insurance on out-of-pocket payments among urban households in Iran.

In this applied, descriptive-analytic study, conducted in 2016, a sample of 17809 urban households in different provinces were recruited from the Center of Statistics of Iran. A household cost-income questionnaire, prepared and completed by the Center of Statistics of Iran, was used to collect data which were then analyzed by using the Stata 14 and double sample selection method.

The results showed that the household head's literacy and marital status, the family size, the number of children and elderly, wealth, per capita income and expenditures on education and tobacco had a direct effect on the probability of buying health insurance. Furthermore, households with one type of health insurance had to tolerate more out-of-pocket payments than the other households and finally, households with health insurance, social security insurance and other insurances experienced the highest out-of-pocket payments.

The significant difference between the out-of-pocket payments to different insurance types necessitates the establishment of an integrated insurance system which provides the same level of goods and services to all people in the community. On the other hand, the harmonization of health tariffs can reduce the inequality in out-of-pocket payments among the households. Moreover, it is recommended to have a system for monitoring the quality of care.