To read the full version of this content please select one of the options below:

Socioeconomic inequality in catastrophic healthcare expenditures in Western Iran: A decomposition analysis

Satar Rezaei (Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, The Islamic Republic of Iran)
Mohammad Hajizadeh (Faculty of Health, Dalhousie University, Halifax, Canada)
Sina Ahmadi (Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, The Islamic Republic of Iran)
Sadaf Sedghi (Department of Economics, Bu-Ali Sina University, Hamedan, Iran)
Bakhtiar Piroozi (Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, The Islamic Republic of Iran)
Amjad Mohamadi-Bolbanabad (Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, The Islamic Republic of Iran)
Enayatollah Homaie Rad (Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, The Islamic Republic of Iran)

International Journal of Social Economics

ISSN: 0306-8293

Article publication date: 16 September 2019

Issue publication date: 4 October 2019

Abstract

Purpose

Financial protection of households against catastrophic healthcare expenditure (CHE) is defined as one of the main goals in health systems. The purpose of this paper is to measure and decompose socioeconomic inequality in CHE among households in Kermanshah province, Western of Iran.

Design/methodology/approach

This cross-sectional study was carried out among 1,188 households in 2017. Data were extracted from the Household Income and Expenditure Survey which is conducted by the Statistical Center of Iran. The CHE is defined as household healthcare expenditure greater than or equal to the 40 percent of household’s “capacity to pay.” The concentration curve and the Wagstaff (W) and Erreygers (E) indexes were used to illustrate and measure the extent of socioeconomic inequality in CHE. In addition, the authors decomposed the W and E indexes to identify the main determinants of socioeconomic inequality in CHE.

Findings

The results indicated that the prevalence of CHE among households was 4.12 percent (95% confidence interval (CI): 3.13 to 5.42 percent). The estimated value of the W and E indexes were −0.2849 (95% CI: −0.4493 to −0.1205) and −0.0451 (95% CI: −0.0712 to −0.0190), respectively; suggesting the concentration of CHE prevalence among the poor households. Decomposition analyses indicated socioeconomic status as the most important factor contributing to the concentration of CHE among the poor. In contrast, health insurance coverage was found to increase the concentration of CHE among the rich in Iran.

Originality/value

The current study demonstrated a higher concentration of CHE among the poor households in Kermanshah province. These results call for the government’s efforts to reduce healthcare expenditure among socioeconomically disadvantaged populations. Further studies are required to understand the mechanisms through which health insurance coverage increased the probability of CHE among rich in Kermanshah province.

Keywords

Acknowledgements

This study was extracted from the Kermanshah University of Medical Sciences approved project and was funded and supported by the Research Deputy of Kermanshah University of Medical Sciences (Grant No. 94412). The authors thank Benjamin Keefe for proofreading the manuscript.

Citation

Rezaei, S., Hajizadeh, M., Ahmadi, S., Sedghi, S., Piroozi, B., Mohamadi-Bolbanabad, A. and Homaie Rad, E. (2019), "Socioeconomic inequality in catastrophic healthcare expenditures in Western Iran: A decomposition analysis", International Journal of Social Economics, Vol. 46 No. 9, pp. 1049-1060. https://doi.org/10.1108/IJSE-01-2019-0034

Publisher

:

Emerald Publishing Limited

Copyright © 2019, Emerald Publishing Limited