Impoverishing Health Expenditure in Iran Before and After the COVID-19 Pandemic: A National Cross-sectional Study

Ali  Darvishi; Vahid  Yazdi-Feyzabadi; Mina  Bahrampour; Mohsen  Bayati; Mohammad Hossein  Mehrolhassani; Mohammadreza  Sheikhy-Chaman

doi:10.18502/htaa.v9i3.19640

Ali Darvishi Department of Health Policy and Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Vahid Yazdi-Feyzabadi Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Mina Bahrampour Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.
Mohsen Bayati Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Mohammad Hossein Mehrolhassani Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Mohammadreza Sheikhy-Chaman Department of Health Services Management, TeMS.C., Islamic Azad University, Tehran, Iran.

DOI: https://doi.org/10.18502/htaa.v9i3.19640

Keywords: Out-of-Pocket (OOP) Payments; Impoverishing Health Expenditure; COVID-19; Health Equity; Iran

Abstract

Background: The COVID-19 pandemic has altered healthcare service utilization patterns and, consequently, the financial protection indicators.

Objectives: This study aims to examine the impoverishment caused by health expenditures before and during the COVID-19 pandemic in Iran.

Methods: This retrospective-descriptive study was conducted using six years of national income and expenditure data (2016 - 2021) from 228,910 households. We measured the occurrence and intensity indices of impoverishing health expenditure, such as the poverty headcount (PH), normalized poverty gap (NPG), and normalized mean positive poverty gap (NMPG), at the rural and urban levels separately. Results: The PH increased from 2016 to 2018, decreased in 2019, and rose again in 2020 and 2021. Moreover, the occurrence of impoverishment health expenditure was at its lowest level in 2016 compared to previous years. PH was consistently higher in rural areas. NPG increased from 2016 to 2018, decreased in 2019, and increased again in 2020 and 2021. The NMPG index ranged from 0.11% to 0.62% in rural areas, and from 0.34% to 1.18% in urban areas.

Conclusion: Impoverishing health expenditure in Iran was significant, especially for rural residents. The COVID-19 pandemic did not change this trend. Reforming economic policies and providing targeted financial support for vulnerable populations are crucial.