Document Type : Original Article


1 Statistical Research and Training Center of Iran, Tehran, Iran

2 School of Public Health, Tehran University of Medical Science, Tehran, Iran


INTRODUCTION: Protection against financial risks is one of the important goals of the health
system. The present study aims to determine the rate of exposure to catastrophic expenditures in
the insured inpatients.
METHODS: The present study was cross‑sectional one which is conducted in 2016. The statistical
population comprised all the insured patients presenting to a private hospital in Qom who presented
to the hospital within 4 months from December 2015 to March 2016. Random convenience sampling
method was used, and the sample size was estimated at 267 people using Cochran formula.
A questionnaire was employed for data gathering. Data were analyzed using Chi‑square test and
logistic regression using SPSS software version 20.
RESULS: Patients exposed to catastrophic expenditures of treatment accounted for the 54.8% of
the cases. The highest rate of being exposed to the catastrophic expenditures was related to the
insured patients of the Universal Health Insurance Fund (UHIF). People with rural insurance, on
average, paid the highest cost of treatment in the hospital. The surgical ward and critical care unit
accounted for the biggest percentage of the patients who incurred catastrophic expenditures. Being
rural, longer length of stay, lower education of the head of the household, lack of supplementary
insurance coverage, and being in UHIF coverage have a substantial relationship with being exposed
to catastrophic expenditures.
DISCUSSION: The socioeconomic status of the insured people in the UHIF and the Rural Insurance
Fund was worse than other funds in terms of less utilization and higher rate of exposure to catastrophic
expenditures, and this issue requires the adoption of specific targeted policies for these groups in
respect with reducing out‑of‑pocket payments through mechanism such as stepwise copayments,
maximum out‑of‑pocket limit, fee exemptions or waiver and providing supplementary insurance to
reduce the exposure to catastrophic expenditures.


1. O’Donnell OA, Wagstaff A. Analyzing Health Equity using
Household Survey Data: A Guide to Techniques and their
Implementation. Washington, D.C: World Bank Publications;
2. Wagstaff A, Doorslaer EV. Catastrophe and impoverishment in
paying for health care: With applications to Vietnam 1993–1998.
Health Econ 2003;12(11):921‑33.
3. Evans DB, Edejer TT, Lauer J, Frenk J, Murray CJ. Measuring
quality: From the system to the provider. Int J Qual Health Care
4. World Health Organization. The World Health Report 2000:
Health Systems: Improving Performance. Geneva: World Health
Organization; 2000.
5. Knaul FM, Arreola‑Ornelas H, Méndez‑Carniado O,
Bryson‑Cahn C, Barofsky J, Maguire R, et al. Evidence is
good for your health system: Policy reform to remedy
catastrophic and impoverishing health spending in Mexico.
Lancet 2006;368(9549):1828‑41.
6. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ,
et al. Household catastrophic health expenditure: A multicountry
analysis. Lancet 2003;362(9378):111‑7.
7. Kavosi Z, Rashidian A, Pourmalek F, Majdzadeh R, Pourreza A,
Mohammad K, et al. Measuring household exposure to
catastrophic health care expenditures: A longitudinal study in
Zone 17 of Tehran. Hakim Res J 2009;12(2):38‑47.
8. Jowett M. Theoretical Insights into the Development of Health
Insurance in Low‑Income Countries; Working Papers 188chedp,
Centre for Health Economics, University of York; 2004.
9. Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F,
Hosseinpour AR, et al. Inequality in household catastrophic health
care expenditure in a low‑income society of Iran. Health Policy
Plan 2012;27(7):613‑23.
10. Health Sector Revolution plan. Tehran: Ministry of Health and
Medical Education; 2014.
11. Yazdi‑Feyzabadi V, Mehrolhassani MH, Darvishi A. Measuring
catastrophic health expenditures and its inequality: Evidence
from Iran’s health transformation program. Health Policy Plan
12. Ghiasvand H, Hadian M, Maleki M. Relationship between
health insurance and catastrophic medical payment in hospitals
affiliated to Iran university of medical science 2009. J Econ Res
13. Ghiasvand H, Hadian M, Maleki M, Shabaninejad H.
Determinants of catastrophic medical payments in hospitals
affiliated to Iran university of medical sciences 2009. Hakim Res
J 2010;13(3):145‑54.
14. Anbari Z, Mohammadbeigi A, Mohammadsalehi N, Ebrazeh A.
Health expenditure and catastrophic costs for inpatient‑ and
out‑patient care in Iran. Int J Prev Med 2014;5(8):1023‑8.
15. Hatam N, Orejlu PH, Jafari A, Kavosi Z. Catastrophic healthcare
expenditures of hospitalized patients in the hospitals of Shiraz
in 2013. Shiraz E Med 2015;16(5):3‑7.
16. Ghiasvand H, Sha’baninejad H, Arab M, Rashidian A.
Hospitalization and catastrophic medical payment: Evidence from
hospitals located in Tehran. Arch Iran Med 2014;17(7):507‑13.
17. Ghiasvand H, Gorji HA, Maleki M, Hadian M. Catastrophic
health expenditure among Iranian rural and urban households,
2013‑2014. Iran Red Crescent Med J 2015;17 (9): e30974.
18. Kavosi Z, Delavari H, Keshtkaran A, Setoudehzadeh F.
Catastrophic health expenditures and coping strategies in
households with cancer patients in Shiraz Namazi hospital.
Middle East J Cancer 2014;5(1):13‑22.
19. Aryankhesal A, Etemadi M, Mohseni M, Azami‑Aghdash S,
Nakhaei M. Catastrophic health expenditure in Iran: A review
article. Iran J Public Health 2018;47(2):166‑77.
20. Panahi H, Janati A, Narimani M, Assadzadeh A,
Mohammadzadeh P, Naderi A. Catastrophic expenditures for
hospitalized patients in Tabriz, Iran. Payesh 2014;13(6):655‑63.
21. Ekman B. Catastrophic health payments and health insurance:
Some counterintuitive evidence from one low‑income country.
Health Policy 2007;83(2):304‑13. e27868.
22. Lankarani KB, Ghahramani S, ZakeriM, Joulaei H. Lessons learned
from national health accounts in Iran: Highlighted evidence for
policymakers. Shiraz E Med J 2015;16(4):1‑3.
23. Ibrahimipour H, Maleki MR, Brown R, Gohari M, Karimi I,
Dehnavieh R. A qualitative study of the difficulties in reaching
sustainable Universal Health Insurance Coverage in Iran. Health
Policy Plan 2011;26(6):485‑95.
24. Tofighi S, Asefzadeh S, Mamikhani J, Sadeghifar J. The impact
of rural health insurance on reduction of catastrophic health
expenditure (CHE). J Appl Environ Biol Sci 2014;4(5):154‑60.
25. Universal Health Coverage in Iran. Tehran: Islamic Republic of
Iran’s National Institute of Health Research; 2014.
26. Wagstaff A, Lindelow M. Can insurance increase financial risk?
The curious case of health insurance in China. J Health Econ
27. Ghorbanian A, Rashidian A, Lankarani KB, Kavosi Z. The
prevalence and determinants of catastrophic health expenditures
in Iran: A systematic review and meta‑analysis. Health Scope