Health Care Utilization and Expenditure in War Survivors

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.