Rezaei Satar, Mohammadi Gharehghani Mohammad Ali, Ahmadi Sina
Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
J Health Popul Nutr. 2025 Mar 26;44(1):87. doi: 10.1186/s41043-025-00828-z.
Healthcare systems must not only improve health outcomes but also protect individuals from financial hardship caused by healthcare costs. This study aimed to investigate financial protection and economic inequality in catastrophic dental healthcare expenditure (CDHE) and catastrophic medicine expenditure (CME) among the insured households through the Social Security Organization (SSO) in Iran.
This cross-sectional study gathered data from 1679 insured households across 5 provinces, utilizing a multistage sampling approach. The prevalence of CDHE and CME was assessed by determining the proportion of households spending at least 40% of their capacity to pay on dental care and medications. Logistic regression analysis was used to identify the factors contributing to CDHE and CME. The concentration curve (CC) and concentration index (CI) were employed to visualize and quantify the extent of economic inequality in CDHE and CME. The CI was further decomposed to identify the primary factors driving the observed economic inequality in CDHE and CME.
The study found that 6.2% (95% confidence interval CI 5.1 to 7.4%) of households experienced CDHE and 4.9% (95% CI 4.0 to 6.0%) experienced CME. The CI for dental costs and medication costs were 0.248 (95% CI 0.115 to 0.381) and was 0.149 (95%CI 0.087 to 0.211), respectively, indicating that these costs were more concentrated among socioeconomically advantaged households. Conversely, the CI for CDHE and CME were -0.185 (95% CI -0.297 to -0.073) and -0.570 (95% CI -0.692 to -0.448), respectively, suggesting that these outcomes were more prevalent among poorer households. The decomposition analysis highlighted that the household wealth index explained 45.4% and 22.5% of the concentration of CDHE and CME among the poor, respectively.
The financial burden imposed by out-of-pocket (OOP) payments for dental care and medication was substantial among households insured by the SSO. Expanding insurance coverage for these services could significantly reduce OOP spending and the likelihood of health expenditures leading to poverty, particularly among lower-income households.
医疗保健系统不仅要改善健康结果，还要保护个人免受医疗费用导致的经济困难。本研究旨在通过伊朗社会保障组织（SSO）调查参保家庭中灾难性牙科医疗支出（CDHE）和灾难性药品支出（CME）方面的经济保护和经济不平等情况。
本横断面研究采用多阶段抽样方法，收集了5个省份1679个参保家庭的数据。通过确定在牙科护理和药品上支出至少占其支付能力40%的家庭比例，评估CDHE和CME的患病率。采用逻辑回归分析确定导致CDHE和CME的因素。使用浓度曲线（CC）和浓度指数（CI）来可视化和量化CDHE和CME中经济不平等的程度。进一步分解CI以确定导致观察到的CDHE和CME经济不平等的主要因素。
研究发现，6.2%（95%置信区间CI 5.1%至7.4%）的家庭经历了CDHE，4.9%（95%CI 4.0%至6.0%）的家庭经历了CME。牙科费用和药品费用的CI分别为0.248（95%CI 0.115至0.381）和0.149（95%CI 0.087至0.211），表明这些费用在社会经济优势家庭中更为集中。相反，CDHE和CME的CI分别为-0.185（95%CI -0.297至-0.073）和-0.570（95%CI -0.692至-0.448），这表明这些结果在较贫困家庭中更为普遍。分解分析突出显示，家庭财富指数分别解释了贫困家庭中CDHE和CME集中度的45.4%和22.5%。
对于SSO参保家庭而言，自付牙科护理和药品费用带来的经济负担很重。扩大这些服务的保险覆盖范围可显著减少自付支出以及健康支出导致贫困的可能性，尤其是在低收入家庭中。
