Journal of Preventive Medicine and Public Health

Original Articles

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019: Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati; J Prev Med Public Health. 2024;57(1):65-72. Published online November 25, 2023; DOI: https://doi.org/10.3961/jpmph.23.291

804 View
68 Download
1 Crossref

Objectives
Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019.
Methods
Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE.
Results
The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05).
Conclusions
Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.

Summary

Key Message
• The aim of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran. • Catastrophic health expenditures (CHE) are used for monitoring financial protection within health systems. • The World Health Organization defines CHE as out-of-pocket payments for healthcare that exceed 40% of a household’s capacity to pay. • In Iran, the prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. • Continuous monitoring of CHE and its determinants is essential for implementing effective strategies aimed at enhancing financial protection.

Citations

Citations to this article as recorded by

An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021
Askhat Shaltynov, Yulia Semenova, Madina Abenova, Assel Baibussinova, Ulzhan Jamedinova, Ayan Myssayev
Scientific Reports.2024;[Epub] CrossRef

The Impact of Public Transfer Income on Catastrophic Health Expenditures for Households With Disabilities in Korea: Eun Jee Chang, Sanggu Kang, Yeri Jeong, Sungchan Kang, Su Jin Kang; J Prev Med Public Health. 2023;56(1):67-76. Published online January 16, 2023; DOI: https://doi.org/10.3961/jpmph.22.183

1,584 View
77 Download
1 Crossref

Abstract Summary PDF

Objectives
Previous studies have reported that people with disabilities are more likely to be impoverished and affected by excessive medical costs than people without disabilities. Public transfer income (PTI) reduces financial strain in low-income households. This study examined the impact of PTI on catastrophic health expenditures (CHE), focusing on low-income households and households with Medical Aid beneficiaries that contained people with disabilities.
Methods
We constructed a panel dataset by extracting data on registered households with disabilities from the Korea Welfare Panel Study 2012-2019. We then used a generalized estimating equation model to estimate the impacts of PTI on CHE. A subgroup analysis was carried out to assess the moderating effects of family income levels and health insurance types.
Results
As PTI increased, the odds ratio (OR) of CHE in households that contained people with disabilities decreased significantly (OR, 0.92; 95% confidence interval [CI], 0.89 to 0.94; p<0.001). In particular, PTI effectively reduced the likelihood of CHE for low-income households (OR, 0.85; 95% CI, 0.81 to 0.89; p<0.001) and those who received medical benefits (OR, 0.78; 95% CI, 0.68 to 0.89; p<0.001).
Conclusions
This study highlights the positive effect of PTI on decreasing CHE. Household income and the health insurance type were significant effect modifiers, but economic barriers seemed to persist among low-income households with non-Medical Aid beneficiaries. Federal policies or programs should consider increasing the total amount of PTI targeting low-income households with disabilities that are not covered by the Medical Aid program.

Summary

Korean summary
장애인은 비장애인에 비해 소득수준이 낮고 빈곤율이 높으며, 저소득 장애인 가구일수록 소득원천 비중에서 공적이전소득 의존성이 높다. 본 연구는 공적이전소득이 장애인 가구의 재난적 의료비 발생 확률(Odds ratio)을 효과적으로 낮춘다는 점을 밝혔으며, 특히 저소득층 및 의료급여 수급 가구에서 의료비 부담 완화 효과가 큰 것을 확인하였다. 향후 의료급여 적용대상에서 제외되어 건강보험에 가입해 있는 저소득 장애인 가구를 대상으로 추가적인 맞춤형 지원 정책이 필요하다.

Citations

Citations to this article as recorded by

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
Journal of Preventive Medicine and Public Health.2024; 57(1): 65. CrossRef

Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households: Ehsan Aghapour, Mehdi Basakha, Seyed Hossein Mohaqeqi Kamal, Abolghasem Pourreza; J Prev Med Public Health. 2022;55(4):379-388. Published online June 27, 2022; DOI: https://doi.org/10.3961/jpmph.22.123

2,359 View
76 Download
1 Crossref

Abstract PDF

Objectives
Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.
Methods
This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.
Results
Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.
Conclusions
In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

Summary

Citations

Citations to this article as recorded by

Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics
Neda Soleimanvandiazar, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, SalahEddin Karim, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Ameneh Setareh Forouzan
INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2024;[Epub] CrossRef

Effects of the Out-of-pocket Payment Exemption in the Public Health Center on Medical Utilization of the Korean Elderly: Kiryong Nam, Eunhye Park, Yuhjin Chung, Chang-yup Kim; J Prev Med Public Health. 2020;53(6):455-464. Published online October 20, 2020; DOI: https://doi.org/10.3961/jpmph.20.341

3,098 View
130 Download
1 Crossref

Abstract PDF

Objectives
The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals.
Methods
This study used online data on Korean national law to gather information on individual local governments’ regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources.
Results
The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48).
Conclusions
The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.

Summary

Citations

Citations to this article as recorded by

Access of older people to primary health care in low and middle-income countries: A systematic scoping review
Saydeh Dableh, Kate Frazer, Diarmuid Stokes, Thilo Kroll, Dirceu Henrique Paulo Mabunda
PLOS ONE.2024; 19(4): e0298973. CrossRef

Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017: Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli; J Prev Med Public Health. 2020;53(4):266-274. Published online June 10, 2020; DOI: https://doi.org/10.3961/jpmph.20.035

4,388 View
189 Download
8 Crossref

Abstract PDF Supplementary Material

Objectives
Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017.
Methods
We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index.
Results
The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05).
Conclusions
Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

Summary

Citations

Citations to this article as recorded by

Causes of death among international travellers in Peru, 2017 to 2021
Kasim Allel, Miguel M Cabada, Collen Lau, Deborah Mills, Richard C Franklin, Yan Zhu, Luis Furuya-Kanamori
Journal of Travel Medicine.2024;[Epub] CrossRef
Informal payments in health facilities in Peru in 2018: Analysis of a cross-sectional survey
Laura Espinoza-Pajuelo, Patricia Mallma, Hannah Hogan Leslie, Patricia Jannet García, Sarthak Gaurav
PLOS Global Public Health.2024; 4(1): e0001837. CrossRef
An Examination of Inter-State Variation in Utilization of Healthcare Services, Associated Financial Burden and Inequality: Evidence from Nationally Representative Survey in India
Aashima, Rajesh Sharma
International Journal of Social Determinants of Health and Health Services.2024;[Epub] CrossRef
Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
Journal of Preventive Medicine and Public Health.2024; 57(1): 65. CrossRef
High cost drugs in Latin America: access and barriers
Diego Rosselli
Expert Review of Pharmacoeconomics & Outcomes Research.2023; 23(6): 619. CrossRef
Determinants of Eye Care Service Utilization among Peruvian Adults: Evidence from a Nationwide Household Survey
Antonio Barrenechea-Pulache, Andres Portocarrero-Bonifaz, Akram Hernández-Vásquez, Carlos Portocarrero-Ramos, Jenny Moscoso-Carrasco
Ophthalmic Epidemiology.2022; 29(3): 339. CrossRef
Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature
Taslima Rahman, Dominic Gasbarro, Khurshid Alam
Health Research Policy and Systems.2022;[Epub] CrossRef
THE IGNORED PANDEMIC OF PUBLIC HEALTH CORRUPTION: A CALL FOR ACTION AMID AND BEYOND SARS-COV-2/COVID-19
Jorge A. Sánchez-Duque, Zhaohui Su, Diego Rosselli, Maria Camila Chica-Ocampo, Maria Isabel Lotero-Puentes, Ana M. Bolaños-Portilla, Manish Dhawan, Alfonso J. Rodríguez-Morales, Kuldeep Dhama
Journal of Experimental Biology and Agricultural Sciences.2021; 9(2): 108. CrossRef

Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran: Satar Rezaei, Mohammad Hajizadeh; J Prev Med Public Health. 2019;52(4):214-223. Published online June 14, 2019; DOI: https://doi.org/10.3961/jpmph.19.046

6,343 View
215 Download
15 Crossref

Abstract PDF

Objectives
Equity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran.
Methods
A total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran.
Results
The prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran.
Conclusions
This study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.

Summary

Citations

Citations to this article as recorded by

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
Journal of Preventive Medicine and Public Health.2024; 57(1): 65. CrossRef
Examining the level and distribution of catastrophic health expenditure from 2013 to 2018: A province-level study in China
Mingsheng Chen, Lizheng Xu, Lei Si, Zhonghua Wang, Stephen Jan
Economic Modelling.2023; 121: 106233. CrossRef
Equity and extent of financial risk protection indicators during COVID-19 pandemic in rural part of Tamil Nadu, India
Yuvaraj Krishnamoorthy, Sathish Rajaa, Isha Sinha, Murali Krishnan, Gerald Samuel, Krishna Kanth
Heliyon.2023; 9(8): e18902. CrossRef
Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain
Samuel López-López, Raúl del Pozo-Rubio, Marta Ortega-Ortega, Francisco Escribano-Sotos
The European Journal of Health Economics.2022; 23(7): 1187. CrossRef
User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran
Manal Etemadi, Mohammad Hajizadeh
BMC Health Services Research.2022;[Epub] CrossRef
A 25-Year Trend of Catastrophic Health Expenditure and Its Inequality in China: Evidence from Longitudinal Data
Yongjian Xu, Yiting Zhou, Andi Pramono, Yazhuo Liu, Cong Jia
Risk Management and Healthcare Policy.2022; Volume 15: 969. CrossRef
Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran
Farhad Pourfarzi, Telma Zahirian Moghadam, Hamed Zandian
Journal of Preventive Medicine and Public Health.2022; 55(3): 297. CrossRef
Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature
Taslima Rahman, Dominic Gasbarro, Khurshid Alam
Health Research Policy and Systems.2022;[Epub] CrossRef
Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder
Lina Diaz-Castro, Héctor Cabello-Rangel, Carlos Pineda-Antúnez, Alejandra Pérez de León
Global Mental Health.2021;[Epub] CrossRef
Unmet dental care need in West of Iran: determinants and inequality
Amjad Mohamadi-Bolbanabad, Farman Zahir Abdullah, Hossein Safari, Satar Rezaei, Abdorrahim Afkhamzadeh, Shina Amirhosseini, Afshin Shadi, Jamal Mahmoudpour, Bakhtiar Piroozi
International Journal of Human Rights in Healthcare.2021; 14(5): 426. CrossRef
The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran
Abraha Woldemichael, Satar Rezaei, Ali Kazemi Karyani, Mohammad Ebrahimi, Shahin Soltani, Abbas Aghaei
BMC Public Health.2021;[Epub] CrossRef
Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017
Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli
Journal of Preventive Medicine and Public Health.2020; 53(4): 266. CrossRef
Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality

Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad, Ghobad Moradi, Hossein Safari, Shahnaz Ghafoori, Yadolah Zarezade, Farzam Bidarpour, Satar Rezaei
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2020; Volume 13: 2865. CrossRef
Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect
Satar Rezaei, Abraha Woldemichael, Mohammad Ebrahimi, Sina Ahmadi
Journal of the Egyptian Public Health Association.2020;[Epub] CrossRef
Catastrophic Out-of-Pocket Health Expenditure Among Rural Households in the Semi-Pastoral Community, Western Ethiopia: A Community-Based Cross-Sectional Study
Debelo Shikuro, Mezgebu Yitayal, Adane Kebede, Ayal Debie
ClinicoEconomics and Outcomes Research.2020; Volume 12: 761. CrossRef

Effects of Air Pollution on Public and Private Health Expenditures in Iran: A Time Series Study (1972-2014): Pouran Raeissi, Touraj Harati-Khalilabad, Aziz Rezapour, Seyed Yaser Hashemi, Abdoreza Mousavi, Saeed Khodabakhshzadeh; J Prev Med Public Health. 2018;51(3):140-147. Published online May 14, 2018; DOI: https://doi.org/10.3961/jpmph.17.153

7,605 View
194 Download
16 Crossref

Abstract PDF

Objectives
Environmental pollution is a negative consequence of the development process, and many countries are grappling with this phenomenon. As a developing country, Iran is not exempt from this rule, and Iran pays huge expenditures for the consequences of pollution. The aim of this study was to analyze the long- and short-run impact of air pollution, along with other health indicators, on private and public health expenditures.
Methods
This study was an applied and developmental study. Autoregressive distributed lag estimating models were used for the period of 1972 to 2014. In order to determine the co-integration between health expenditures and the infant mortality rate, fertility rate, per capita income, and pollution, we used the Wald test in Microfit version 4.1. We then used Eviews version 8 to evaluate the stationarity of the variables and to estimate the long- and short-run relationships.
Results
Long-run air pollution had a positive and significant effect on health expenditures, so that a 1.00% increase in the index of carbon dioxide led to an increase of 3.32% and 1.16% in public and private health expenditures, respectively. Air pollution also had a greater impact on health expenditures in the long term than in the short term.
Conclusions
The findings of this study indicate that among the factors affecting health expenditures, environmental quality and contaminants played the most important role. Therefore, in order to reduce the financial burden of health expenditures in Iran, it is essential to reduce air pollution by enacting and implementing laws that protect the environment.

Summary

Citations

Citations to this article as recorded by

Evaluating the Role of GDPPer Capita, Air Pollution and Non‐Economic Factors in Determining Health Expenditure: Evidence from Asian Region Using Instrumental Variables Techniques
Samia Nasreen, Aviral Kumar Tiwari, Mehr‐un Nisa, Faryal Ishtiaq
Economic Papers: A journal of applied economics and policy.2024; 43(1): 63. CrossRef
Does climate change drive up government healthcare costs in the European Union?
Adela Socol, Horia Iuga, Dragoș Socol, Iulia Cristina Iuga
Frontiers in Environmental Science.2023;[Epub] CrossRef
An analysis of emission reduction strategy for light and heavy-duty vehicles pollutions in high spatial–temporal resolution and emission
Leila Khazini, Mina Jamshidi Kalajahi, Nadège Blond
Environmental Science and Pollution Research.2022; 29(16): 23419. CrossRef
Air pollution and economic growth under local government competition: Evidence from China, 2007–2016
Shurui Jiang, Xue Tan, Peiqi Hu, Yue Wang, Lei Shi, Zhong Ma, Genfa Lu
Journal of Cleaner Production.2022; 334: 130231. CrossRef
Theoretical Model and Actual Characteristics of Air Pollution Affecting Health Cost: A Review
Xiaocang Xu, Haoran Yang, Chang Li
International Journal of Environmental Research and Public Health.2022; 19(6): 3532. CrossRef
Health is Wealth: A Dynamic SUR Approach of Examining a Link Between Climate Changes and Human Health Expenditures
Muhammad Azam, Abdul Majid Awan
Social Indicators Research.2022; 163(2): 505. CrossRef
Impact of Environmental Quality on Healthcare Expenditures in Developing Countries: A Panel Data Approach
Asim Anwar, Shabir Hyder, Russell Bennett, Mustafa Younis
Healthcare.2022; 10(9): 1608. CrossRef
The impact of air pollution on urban residents’ health expenditure: spatial evidence from Yangtze River Delta, China
Han Sun, Zhihui Leng, Hengsong Zhao, Shan Ni, Chao Huang
Air Quality, Atmosphere & Health.2021; 14(3): 343. CrossRef
Association between health expenditures, economic growth and environmental pollution: Long‐run and causality analysis from Asian economies
Samia Nasreen
The International Journal of Health Planning and Management.2021; 36(3): 925. CrossRef
The relationship between renewable energy use and health expenditures in EU countries
Mahmut Unsal Sasmaz, Aysun Karamıklı, Ulas Akkucuk
The European Journal of Health Economics.2021; 22(7): 1129. CrossRef
Do renewable energy and health expenditures improve load capacity factor in the USA and Japan? A new approach to environmental issues
Ugur Korkut Pata
The European Journal of Health Economics.2021; 22(9): 1427. CrossRef
Development of Reduction Scenarios Based on Urban Emission Estimation and Dispersion of Exhaust Pollutants from Light Duty Public Transport: Case of Tabriz, Iran
Mina Jamshidi Kalajahi, Leila Khazini, Yousef Rashidi, Saeed Zeinali Heris
Emission Control Science and Technology.2020; 6(1): 86. CrossRef
The Impact of Air Pollution on Healthcare Expenditure for Respiratory Diseases: Evidence from the People’s Republic of China

Lele Li, Tiantian Du, Chi Zhang
Risk Management and Healthcare Policy.2020; Volume 13: 1723. CrossRef
Are Air Pollution, Economic and Non-Economic Factors Associated with Per Capita Health Expenditures? Evidence from Emerging Economies
Muhammad Usman, Zhiqiang Ma, Muhammad Wasif Zafar, Abdul Haseeb, Rana Umair Ashraf
International Journal of Environmental Research and Public Health.2019; 16(11): 1967. CrossRef
Health impact and related cost of ambient air pollution in Tehran
Reza Bayat, Khosro Ashrafi, Majid Shafiepour Motlagh, Mohammad Sadegh Hassanvand, Rajabali Daroudi, Günther Fink, Nino Künzli
Environmental Research.2019; 176: 108547. CrossRef
Sağlık Harcamalarının Belirleyicileri Üzerine Bir Uygulama: Çevre Kirliliği ve Yönetişimin Etkilerinin İncelenmesi
Alper KARASOY, Gökhan DEMİRTAŞ
İnsan ve Toplum Bilimleri Araştırmaları Dergisi.2018; 7(3): 1917. CrossRef

Medical Care Expenditure in Suicides From Non-illness-related Causes: Jungwoo Sohn, Jaelim Cho, Ki Tae Moon, Mina Suh, Kyoung Hwa Ha, Changsoo Kim, Dong Chun Shin, Sang Hyuk Jung; J Prev Med Public Health. 2014;47(6):327-335. Published online November 4, 2014; DOI: https://doi.org/10.3961/jpmph.14.038

9,065 View
89 Download
2 Crossref

Abstract PDF

Objectives
Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated.
Methods
Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status.
Results
Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women.
Conclusions
Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

Summary

Citations

Citations to this article as recorded by

Socioeconomic factors associated with suicidal behaviors in South Korea: systematic review on the current state of evidence
Nicolas Raschke, Amir Mohsenpour, Leona Aschentrup, Florian Fischer, Kamil J. Wrona
BMC Public Health.2022;[Epub] CrossRef
Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China
Congrong Li, Qing Han, Jinrong Hu, Zeyu Han, Hongjuan Yang
Frontiers in Public Health.2022;[Epub] CrossRef

Has Income-related Inequity in Health Care Utilization and Expenditures Been Improved? Evidence From the Korean National Health and Nutrition Examination Survey of 2005 and 2010: Eunkyoung Kim, Soonman Kwon, Ke Xu; J Prev Med Public Health. 2013;46(5):237-248. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.237

12,165 View
97 Download
10 Crossref

Abstract PDF

Objectives

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.

Methods

We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.

Results

The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.

Conclusions

We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Summary

Citations

Citations to this article as recorded by

Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study
Yukyung Shin, Ji-su Lee, Young Kyung Do
Journal of Preventive Medicine and Public Health.2022; 55(4): 389. CrossRef
Factors associated with the preventive healthcare service use among older adults in Korea: Focusing on age variation
Jane Park, Sang Kyoung Kahng
Asian Social Work and Policy Review.2021; 15(1): 24. CrossRef
Effect of a Mobile Phone–Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial
Yeoree Yang, Eun Young Lee, Hun-Sung Kim, Seung-Hwan Lee, Kun-Ho Yoon, Jae-Hyoung Cho
JMIR mHealth and uHealth.2020; 8(2): e16266. CrossRef
Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran
Mohammadreza Zakeri, Kamran Bagheri Lankarani, Zahra Kavosi, Ramin Ravangard
Health Scope.2019;[Epub] CrossRef
The inequity of inpatient services in rural areas and the New-Type Rural Cooperative Medical System (NRCMS) in China: repeated cross sectional analysis
Bingbing Pan, Samuel D Towne, Yuxing Chen, ZhaoKang Yuan
Health Policy and Planning.2017; 32(5): 634. CrossRef
The association between objective income and subjective financial need and depressive symptoms in South Koreans aged 60 and older
Woorim Kim, Tae Hyun Kim, Tae‐Hoon Lee, Yeong Jun Ju, Eun‐Cheol Park
Psychogeriatrics.2017; 17(6): 389. CrossRef
The Effect of Occurrence and Reoccurrence of Catastrophic Health Expenditure on Transition to Poverty and Persistence of Poverty in South Korea
Eunkyoung Kim, Soonman Kwon
Health Policy and Management.2016; 26(3): 172. CrossRef
Socioeconomic Disparities in Osteoporosis Prevalence: Different Results in the Overall Korean Adult Population and Single-person Households
Jungmee Kim, Joongyub Lee, Ju-Young Shin, Byung-Joo Park
Journal of Preventive Medicine and Public Health.2015; 48(2): 84. CrossRef
Horizontal inequities in dental service utilization
Eunsuk Ahn, Min Young Kim, Hosung Shin
Journal of Korean Academy of Oral Health.2015; 39(1): 9. CrossRef
Equity in the Utilization of Healthcare Services in India: Evidence From National Sample Survey
Soumitra Ghosh
SSRN Electronic Journal.2014;[Epub] CrossRef

Evaluation Studies

The Effect of Catastrophic Health Expenditure on the Transition to Poverty and the Persistence of Poverty in South Korea.: Eun Cheol Song, Young Jeon Shin; J Prev Med Public Health. 2010;43(5):423-435.; DOI: https://doi.org/10.3961/jpmph.2010.43.5.423

5,949 View
133 Download
19 Crossref

Abstract PDF

OBJECTIVES
The low benefit coverage rate of South Korea's health security system has been continually pointed out. A low benefit coverage rate inevitably causes catastrophic health expenditure, which can be the cause of the transition to poverty and the persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. METHODS: To determine the degree of social mobility, this study was conducted among the 6311 households that participated in the South Korea Welfare Panel Study in both 2006 and 2008. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea was assessed via multiple logistic regression analysis. RESULTS: The poverty rate in South Korea was 21.6% in 2006 and 20.0% in 2008. 25.1 - 7.3% of the households are facing catastrophic health expenditure. Catastrophic health expenditure was found to affect the transition to poverty even after adjusting for the characteristics of the household and the head of the household, at the threshold of 28% or above. CONCLUSIONS: 25.1% of the households in this study were found to be currently facing catastrophic health expenditure, and it was determined that catastrophic health expenditure is a cause of transition to poverty. This result shows that South Korea's health security system is not an effective social safety net. As such, to prevent catastrophic health expenditure and transition to poverty, the benefit coverage of South Korea's health security system needs to the strengthened.

Summary

Citations

Citations to this article as recorded by

The Impact of Public Transfer Income on Catastrophic Health Expenditures for Households With Disabilities in Korea
Eun Jee Chang, Sanggu Kang, Yeri Jeong, Sungchan Kang, Su Jin Kang
Journal of Preventive Medicine and Public Health.2023; 56(1): 67. CrossRef
Food Insecurity, Healthcare Utilization, and Healthcare Expenditures: A Longitudinal Cohort Study
Hwi Choe, Tae-Young Pak
International Journal of Public Health.2023;[Epub] CrossRef
The effect of catastrophic health expenditure on exit from poverty among the poor in South Korea
Eunkyoung Kim, Soonman Kwon
The International Journal of Health Planning and Management.2021; 36(2): 482. CrossRef
Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran
Faranak Ahmadi, Hamidreza Farrokh-Eslamlou, Hasan Yusefzadeh, Cyrus Alinia
BMC Health Services Research.2021;[Epub] CrossRef
The Effect of Mid-to-Long-Term Hospitalization on the Catastrophic Health Expenditure: Focusing on the Mediating Effect of Earned Income Loss
Hyunwoo Jung, Jungyeon Yang, Eunyoung Kim, Junhyup Lee
Healthcare.2021; 9(8): 1013. CrossRef
The impact of poverty transitions on frailty among older adults in South Korea: findings from the Korean longitudinal study of ageing
Hin Moi Youn, Hyeon Ji Lee, Doo Woong Lee, Eun-Cheol Park
BMC Geriatrics.2020;[Epub] CrossRef
Modelling unbalanced catastrophic health expenditure data by using machine‐learning methods
Songul Cinaroglu
Intelligent Systems in Accounting, Finance and Management.2020; 27(4): 168. CrossRef
Relationship Between Catastrophic Health Expenditures and Income Quintile Decline
Jeong-Hee Kang, Chul-Woung Kim
Osong Public Health and Research Perspectives.2018; 9(2): 73. CrossRef
Trends of Health Status and Medical Utilization Among Korean Baby Boomers: Analysis From Korean Health Panel Survey 2008-2014
Soong-Nang Jang
Annals of Geriatric Medicine and Research.2017; 21(1): 24. CrossRef
Inequality Status of Household Medical Expenditure Distribution by Household Income Quartile and Associated Factors with Household Catastrophic Medical Expenditure in Korea
Min Jung Kim, Sin Kam, Won Kee Lee
Journal of Health Informatics and Statistics.2017; 42(3): 232. CrossRef
Family Income Inequality and Medical Care Expenditure In Korea
Yong-Jae Lee
The Journal of the Korea Contents Association.2016; 16(8): 366. CrossRef
The Effect of Occurrence and Reoccurrence of Catastrophic Health Expenditure on Transition to Poverty and Persistence of Poverty in South Korea
Eunkyoung Kim, Soonman Kwon
Health Policy and Management.2016; 26(3): 172. CrossRef
Association between chronic disease and catastrophic health expenditure in Korea
Jae-Woo Choi, Jong-Won Choi, Jae-Hyun Kim, Ki-Bong Yoo, Eun-Cheol Park
BMC Health Services Research.2015;[Epub] CrossRef
Catastrophic Health Expenditures and Life Satisfaction: A Case in South Korea
So-Yun Kim, Gong-Soog Hong
Journal of Family and Economic Issues.2015; 36(3): 369. CrossRef
Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: A quasi-experimental study
Chang-O Kim, Won Oh Joung
Social Science & Medicine.2014; 101: 28. CrossRef
Trends of household income and dental care spending
Hye-sung Kim, Eunsuk Ahn, Min-Young Kim, Sun-Mi Kim, Hosung Shin
Journal of Korean Academy of Oral Health.2014; 38(1): 17. CrossRef
Changes in Economic Status of Households Associated with Catastrophic Health Expenditures for Cancer in South Korea
Jae-Woo Choi, Kyoung-Hee Cho, Young Choi, Kyu-Tae Han, Jeoung-A Kwon, Eun-Cheol Park
Asian Pacific Journal of Cancer Prevention.2014; 15(6): 2713. CrossRef
The Effect of Catastrophic Health Expenditure on the Transition to and Persistence of Poverty in South Korea: Analysis of the Korea Welfare Panel Study Data, 2007-2012
Eun-Cheol Song, Young-Jeon Shin
Health Policy and Management.2014; 24(3): 242. CrossRef
Equity in health care: current situation in South Korea
Hong-Jun Cho
Journal of the Korean Medical Association.2013; 56(3): 184. CrossRef

English Abstract

Effects of Private Health Insurance on Health Care Utilization and Expenditures in Korean Cancer Patients: Focused on 5 Major Cancers in One Cancer Center.: Jin Hwa Lim, Kui Son Choi, Sung Gyeong Kim, Eun Cheol Park, Jae Hyun Park; J Prev Med Public Health. 2007;40(4):329-335.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.329

4,553 View
54 Download
10 Crossref

Abstract PDF

OBJECTIVES
To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. RESULTS: Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. CONCLUSIONS: We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.

Summary

Citations

Citations to this article as recorded by

Treatment interruption during radiation therapy: Experience at a single institution in the Republic of Korea
Jung Ae Lee, Nam Kwon Lee, Won Sup Yoon, Dae Sik Yang, Chul Yong Kim, Se Ryun Lee, Hwa Jeong Seong
Asia-Pacific Journal of Clinical Oncology.2017;[Epub] CrossRef
Cancer Treatment near the End-of-Life Becomes More Aggressive: Changes in Trend during 10 Years at a Single Institute
Younak Choi, Bhumsuk Keam, Tae Min Kim, Se-Hoon Lee, Dong-Wan Kim, Dae Seog Heo
Cancer Research and Treatment.2015; 47(4): 555. CrossRef
Ubiquitous Environment with Private Health Insurance and the Relevance of Length of Stay
Dong-Ruyl Jang, Seong-Woo Choi, Bu-Yeon Park, Sung-Gil Kim
The Journal of the Korea institute of electronic communication sciences.2014; 9(2): 203. CrossRef
Analysis of factors affecting the life quality of the patients with late stomach cancer
Yan‐Mei Ma, Cai‐Feng Ba, Yu‐Bin Wang
Journal of Clinical Nursing.2014; 23(9-10): 1257. CrossRef
The Effect of Private Health Insurance on Health Care Utilization: Evidence from Korea Health Panel (2008~2010)
Chang-Hoon You, Sung-Wook Kang, Ji-Heon Choi, Eun-Hwan Oh, Young-Dae Kwon
The Korean Journal of Health Service Management.2014; 8(2): 101. CrossRef
An Association between Private Health Insurance and Use of Endoscopy, An Association between Private Health Insurance and Use of Endoscopy,
Chang-Hoon You, Young-Dae Kwon, Ji-Heon Choi, Sung-Wook Kang
The Korean Journal of Health Service Management.2014; 8(4): 25. CrossRef
The Influence of Private Health Insurance on Admission among Some Patients with Cervical or Lumbar Sprain
Dong-Ryul Jang, Myung-Geun Kang
Journal of agricultural medicine and community health.2012; 37(2): 84. CrossRef
Private health insurance in South Korea: An international comparison
Jaeun Shin
Health Policy.2012; 108(1): 76. CrossRef
Sociodemographic gradients in breast and cervical cancer screening in Korea: the Korean National Cancer Screening Survey (KNCSS) 2005-2009
Mi Jin Park, Eun-Cheol Park, Kui Son Choi, Jae Kwan Jun, Hoo-Yeon Lee
BMC Cancer.2011;[Epub] CrossRef
Comparison of hospital charge prediction models for gastric cancer patients: neural network vs. decision tree models
Jing Wang, Man Li, Yun-tao Hu, Yu Zhu
BMC Health Services Research.2009;[Epub] CrossRef

Original Articles

Complementary and Alternative Medicine Use in Korea: Prevalence, Pattern of Use, and Out-of-pocket Expenditures.: Sang Il Lee, Young Ho Khang, Moo Song Lee, Hee Jo Koo, Weechang Kang, Changgi D Hong; Korean J Prev Med. 1999;32(4):546-555.

2,450 View
54 Download

Abstract PDF: OBJECTIVES
To determine the prevalence, pattern, and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. METHODS: We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/ pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. RESULTS: The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to pound $1.88 billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/ hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services and CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). CONCLUSION: CAM became a popular source of health care in Korea. Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.; Summary

A quentitative model for the projection of health expenditure.: Han Joong Kim, Young Doo Lee, Chung Mo Nam; Korean J Prev Med. 1991;24(1):29-36.

1,751 View
18 Download

Abstract PDF: A multiple regression analysis using ordinary least square (OLS) is frequently used for the projection of healt expenditure as well as for the identification of factors affecting health care costs. Data for the analysis often have mixed characteristics of time series and cross section. Parameters as a result of OLS estimation, in this case, are no longer the best linear unbiased estimators (BLUE) because the data do not satisfy basic assumptions of regression analysis. The study theoretically examined statistical problems induced when OLS estimation was applied with the time series cross section data. Then both the OLS regression and time series cross section regression (TSCS regression) were applied to the same empirical data. Finally, the difference in parameters between the two estimations were explained through residual analysis.; Summary

English Abstract

Out-of-pocket Health Expenditures by Non-elderly and Elderly Persons in Korea.: Sung Gyeong Kim, Seung Hum Yu, Woong Sub Park, Woo Jin Chung; J Prev Med Public Health. 2005;38(4):408-414.

2,151 View
60 Download

Abstract PDF: OBJECTIVES
The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. METHODS: We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26, 154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. RESULTS: Out-of-pocket health expenditures for those people under the age of 65 averaged 14, 800 won per month, whereas expenditures for those people aged 65 and older averaged 27, 200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. CONCLUSIONS: The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and nonelderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.; Summary

Original Article

Impacts of Implementing Case Payment System to Medical Aid Hemodialysis Patients on Dialysis Frequencies and Expenditure.: Sunhee Lee, Hanjoong Kim, Seungho Shin, Woohyun Cho, Hye Young Kang; J Prev Med Public Health. 2004;37(3):260-266.

2,007 View
37 Download

Abstract PDF: OBJECTIVES
To assess the impacts of implementing case payment system (CPS) to Medical Aid (MA) hemodialysis patients on the frequencies and expenditure of dialysis. METHODS: Fifty-eight clinics and 35 tertiary care hospitals were identified as having a minimum of 10 hemodialysis patients for each of the MA and Medical Insurance (MI) programs, who received hemodialysis from the same dialysis facilities for both periods of July 2001 and July 2002. From these facilities, a total of 2, 167 MA and 2, 928 MI patients were identified as the study subjects. Using electronic claims data, the changes in the total number of monthly treatments and charges for outpatient hemodialysis treatments for each patient after the introduction of the CPS were compared between the MA and MI patients. Multiple regression analyses were performed to examine the independent impact of the CPS on the utilization and expenditure of dialysis treatments among the MA patients. RESULTS: There was a significant decrease in the total charges for the hemodialysis treatments of the MA patients, 3.4% (p< 0.05), whereas a significant increase was observed for the MI patients, 2.5% (p< 0.05). For both the MA and MI patients, the frequency of the monthly hemodialysis treatments were significantly increased, 5.5 (from 12.1 to 12.7) and 7.8% (from 11.6 to 12.5), for the MA and MI patients, respectively. However, a multivariate regression analysis showed no significant difference in the changes in the total number of monthly hemodialysis treatments between the MA and MI patients after implementation of the CPS. Another regression model, regressing on the changes in the monthly claims of dialysis treatments, showed a significant negative coefficient for the MA ( (=-70725, p< 0.05). CONCLUSION: The significant decrease in the total charges for hemodialysis treatments among MA as compared to MI patients suggests that there was a cost reduction in the MA program following the introduction of the CPS.; Summary

First
Prev
Page of 1
Next
Last

Search