Document Type : بیان دیدگاه

Authors

1 PhD Student in Health Economics, Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Associate Professor, Health Economics, Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 Associate Professor of Health Economics, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 MSc student in Health Economics, Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

5 Associate Professor , Health Economics, Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Protecting households from the financial risks associated with healthcare utilization is a fundamental aspect of universal health coverage. Catastrophic health expenditure is a widely used indicator for assessing financial protection, with two principal approaches for its calculation:

• Budget Share Approach: This method assesses household out-of-pocket (OOP) payments as a proportion of total household expenditures or income.

• Capacity to Pay Approach: This method calculates household capacity to pay by deducting essential spending from total household expenditures. Then, the proportion of OOP payments to capacity to pay is calculated.

In recent years, the capacity-to-pay approach has faced criticism, primarily due to its limited ability to accurately capture the extent to which OOP payments compromise essential household resources. Additionally, the approach entails computational complexities that hinder its application. In light of these considerations, adopting the budget share method with a 25% threshold is recommended for monitoring progress toward reducing household exposure to catastrophic health expenditures within the framework of the Seventh Development Plan of the Islamic Republic of Iran.

Keywords

Main Subjects

1.Saksena P, Hsu J, Evans DB. Financial risk protection and universal health coverage: evidence and measurement challenges. PLoS medicine.2014;11(9):e1001701 .
2 . Wagstaff A, Flores G, Hsu J, Smitz M-F, Chepynoga K, Buisman LR, et al. Progress on catastrophic health spending in 133 countries: a retrospective observational study. The Lancet Global Health. 2018;6(2):e169-e79 .
3 . Mousavi A, Mokhtari-Payam M, Fazaeli A, Aliabad MB. Analysis of national health accounts in Iran (2002–2020). Journal of the Iranian Institute for Health Sciences Research. 24(1):7-19.
4 . Hsu J, Flores G, Evans D, Mills A, Hanson K. Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring. International journal for equity in health. 2018;17:1-13 .
5 . Cylus J, Thomson S, Evetovits T. Catastrophic health spending in Europe: equity and policy implications of different calculation methods. Bulletin of the World Health Organization. 2018;96(9):599 .
6 . Nguyen HA, Ahmed S, Turner HC. Overview of the main methods used for estimating catastrophic health expenditure. Cost Effectiveness and Resource Allocation. 2023;21(1):50 .
7 . Wagstaff A. Measuring catastrophic medical expenditures: reflections on three issues. Health economics. 2019;28(6):765-81 .
8 . Hedayati M, Asl IM, Maleki M, Fazaeli AA, Goharinezhad S. The variations in catastrophic and impoverishing health expenditures, and its determinants in Iran: A scoping review. Medical Journal of the Islamic Republic of Iran. 2023;37 .
9. Health Expenditures in I.R.Iran (Household Expenditure and Income Survey of National Statistical Center of Iran, 2023).Comprehensive Report.National Institute for Health Research. 2024 (Autumn)