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Household catastrophic health expenditure and its effective factors: a case of Iran


Ravangard, R and Jalali, FS and Bayati, M and Palmer, AJ and Jafari, A and Bastani, P, Household catastrophic health expenditure and its effective factors: a case of Iran, Cost Effectiveness and Resource Allocation, 19, (1) Article 59. ISSN 1478-7547 (2021) [Refereed Article]


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DOI: doi:10.1186/s12962-021-00315-2



The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018.


The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the "WHO Global Health Survey" questionnaire. CHEs were defined as health expenditures exceeding 40% of households' capacity to pay. Households living below the poverty line before paying for health services were excluded from the study. The associations between the households' characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modeling in SPSS 23.0 at the significance level of 5%.


The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR = 3.14, P-value < 0.001), households with disabled members (OR = 27.98, P-value < 0.001), households with children under 5 years old (OR = 2.718, P-value = 0.02), and those without supplementary health insurance coverage (OR = 1.87, P-value = 0.01).


CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

Item Details

Item Type:Refereed Article
Keywords:catastrophic health expenditures; out-of-pocket payments; financial contribution
Research Division:Economics
Research Group:Applied economics
Research Field:Health economics
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Palmer, AJ (Professor Andrew Palmer)
ID Code:152833
Year Published:2021
Web of Science® Times Cited:4
Deposited By:Research Performance and Analysis
Deposited On:2022-08-25
Last Modified:2022-10-24
Downloads:2 View Download Statistics

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