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Review
. 2020 May 15:18:17.
doi: 10.1186/s12962-020-00212-0. eCollection 2020.

Determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis

Leila Doshmangir  1   2   3 , Mahmood Yousefi  4 , Edris Hasanpoor  5 , Behzad Eshtiagh  3 , Hassan Haghparast-Bidgoli  6
Affiliations
Review

Determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis

Leila Doshmangir et al. Cost Eff Resour Alloc. .

Abstract

Background: Catastrophic health expenditures (CHE) are of concern to policy makers and can prevent individuals accessing effective health care services. The exposure of households to CHE is one of the indices used to evaluate and address the level of financial risk protection in health systems, which is a key priority in the global health policy agenda and an indicator of progress toward the UN Sustainable Development Goal for Universal Health Coverage. This study aims to assess the CHE at population and disease levels and its influencing factors in Iran.

Methods: This study is a systematic review and meta-analysis. The following keywords and their Persian equivalents were used for the review: Catastrophic Health Expenditures; Health Equity; Health System Equity; Financial Contribution; Health Expenditures; Financial Protection; Financial Catastrophe; and Health Financing Equity. These keywords were searched with no time limit until October 2019 in PubMed, Web of Science, Scopus, ProQuest, ScienceDirect, Embase, and the national databases of Iran. Studies that met a set of inclusion criteria formed part of the meta-analysis and results were analyzed using a random-effects model.

Results: The review identified 53 relevant studies, of which 40 are conducted at the population level and 13 are disease specific. At the population level, the rate of CHE is 4.7% (95% CI 4.1% to 5.3%, n = 52). Across diseases, the percentage of CHE is 25.3% (95% CI 11.7% to 46.5%, n = 13), among cancer patients, while people undergoing dialysis face the highest percentage of CHE (54.5%). The most important factors influencing the rate of CHE in these studies are health insurance status, having a household member aged 60-65 years or older, gender of the head of household, and the use of inpatient and outpatient services.

Conclusion: The results suggest that catastrophic health spending in Iran has increased from 2001 to 2015 and has reached its highest levels in the last 5 years. It is therefore imperative to review and develop fair health financing policies to protect people against financial hardship. This review and meta-analysis provides evidence to help inform effective health financing strategies and policies to prioritise high-burden disease groups and address the determinants of CHE.

Keywords: Catastrophic health expenditures; Fair health financing; Health equity; Iran.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of studies included in the meta-analysis
Fig. 2
Fig. 2
Funnel plot for evaluation of publication bias
Fig. 3
Fig. 3
The pooled estimate of CHE prevalence in Iran (population level)
Fig. 4
Fig. 4
The pooled estimate of CHE prevalence obtained from subgroups’ meta-analysis (diseases level)
See this image and copyright information in PMC

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