Catastrophic Health Expenditure and Impoverishment Among Households with Cardiovascular Patients in Tehran, 2017

Considering the high prevalence and burden of cardiovascular diseases in Iran and the health expenditures imposed on households, the present study aimed to investigate the catastrophic and impoverishing health expenditures among households having cardiovascular patients.

This descriptive-analytical and cross-sectional study was conducted from March 2017 to September 2017. Data were collected from 385 patients who referred to the three main hospitals providing cardiovascular care in Tehran. Demographic and socioeconomic data, household income, out-of-pocket payments of households having cardiovascular patients were collected via face-to-face interviews and based on the expenditure part of the World Health Organization’s Health Survey questionnaire. The occurrence of catastrophic and impoverishing health expenditures due to cardiovascular care was calculated by income deciles. To identify the determinants of catastrophic and impoverishing expenditures, logistic regression was used.

In this study, 24.6% of all households having cardiovascular patients experienced catastrophic health expenditures. Furthermore, the extent of experiencing impoverishing expenditures was 3.8% among the households. The variables such as education level, type of health insurance, household income, outpatient and inpatient expenditures had a significant relationship with the occurrence of catastrophic health expenditures. Moreover, the type of health insurance, household income, and inpatient expenditures had a significant relationship with the incidence of impoverishing health expenditures.

Mechanisms such as the development of financial risk pooling in the cardiovascular care setting, using generic medicines instead of brand names in patients and excluding poor patients’ from payments can be effective for financial empowerment and reduction of the catastrophic and impoverishing health expenditures among cardiovascular patients.