Investigating the Factors Affecting Hospital Expenditures of Iranian Urban Households: Emphasis on Maternal Education

Document Type : Original Article

Authors

Assistant professor of Economics, Faculty of Management and Human Science, Chabahar Maritime University, Chabahar, Iran

Abstract


Introduction: Considering the high proportion of hospital expenditures in out-of-pocket payments and the importance of controlling and managing hospital expenditures to prevent catastrophic costs, the main purpose of this study was to investigate the factors affecting the hospital expenditures of Iranian urban household with emphasis on maternal education.
Method: The present study is a descriptive-analytical and applied research conducted at national level using econometrics Heckman two-step model. The sample size included 15740 urban households of  Iranian provinces in 2017 that was selected according to Cochran formula and three-stage sampling by the Statistical Centre of Iran. The data were also extracted from different sections of the standard questionnaire "Urban Household Cost-Income" of the Statistical Centre of Iran and processed in Stata 10 software.
Results: Higher education and employment of mothers have led to a decrease in the probability of household facing hospital expenditures, by 0.002% and 0.9%, respectively. Mother’s employment, having supplementary health insurance, and bachelor's or higher education of mother resulted in a decrease in per capita hospital expenditures of households by 2058123, 1361437 and 3647518 Rials, respectively. An increase in household size, having children under the age of seven and elderly persons over sixty years old, and mothers with elementary education led to an increase in household hospital expenditures by 1347241, 4406778, 1602637 and 1674286 Rials, respectively.
Conclusion: Regarding the greater impact of aging of mothers, compared to fathers, and having children and elderly persons in the household and increased hospital expenditures, protection and support of such households is necessary to achieve better health status and reduce household hospital expenditures, which  can be achieved through improving and discounting insurance coverage and preventive health care. Also, investing in education to provide an appropriate condition for education of most people in the community, as well as enhancing parental health literacy through health education, is recommended.

Keywords

References

1. Yazdi-Feyzabadi V, Bahrampour M, Rashidian A, Haghdoost AA, Akbari Javar M, Mehrolhassani MH. Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey. Int J Equity Health. 2018;17(1):44. doi: 10.1186/s12939-018-0743-y.
2. Rezaei S, Dindar A, Rezapour A. Health care expenditures and their determinants: Iran provinces (2006-2011). Journal of Health Administration (JHA). 2016;19(63):81-90. Persian.
3. Shahraki M, Ghaderi S. The Effect of Socioeconomic Factors on Household Health Expenditures: Heckman Two-Step Method. Journal of Payavard Salamat. 2019;13(2):160-71. Persian.
4. Savojipour S, Assari AA, Agheli L, Hassanzadeh A. Modeling healthcare expenditure among iranian households. Journal of Economic Growth and Development Research. 2018;8(29):97-110. Persian.
5. Ghiasvand H, Abolghasem Gorji H, Maleki M, Hadian M. Catastrophic Health Expenditure Among Iranian Rural and Urban Households, 2013 - 2014. Iran Red Crescent Med J. 2015;17(9):e30974. doi: 10.5812/ircmj.30974.
6. Panahi H, Salmani B, Nasibparast S. Inductive effect of physicians number and hospital bed on health expenditures in Iran. Quarterly Journal of Applied Theories of Economics. 2015;2(2):25-42. Persian.
7. Shahraki M, Ghaderi S. The impact of children’s entry to labor market on health expenditures of urban household. Journal of Research and Health. 2019;9(5):428-36. doi: 10.29252/jrh.9.5.428 .
8. Hajizadeh M, Nghiem HS. Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments? Int J Health Care Finance Econ. 2011;11(4):267-85. doi: 10.1007/s10754-011-9099-1.
9. 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.
10. Bernal-Delgado E, Comendeiro-Maaloe M, Ridao-Lopez M, Sanso Rossello A. Factors underlying the growth of hospital expenditure in Spain in a period of unexpected economic shocks: A dynamic analysis on administrative data. Health Policy. 2020;124(4):389-96. doi: 10.1016/j.healthpol.2020.02.001.
11. Rezaei S, Hajizadeh M. Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran. J Prev Med Public Health. 2019;52(4):214-23. doi: 10.3961/jpmph.19.046.
12. 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. doi: 0141707/AIM.0012.
13. Ghaderi S. The Impact of medical Insurances on out-of-pocket payments among urban households in Iran: A Double-Sample selection Model. Journal of Health Administration. 2019;22(2):41-54. Persian.
14. Meng Z, Zhu M, Cai Y, Cao X, Wu H. Effect of a typical systemic hospital reform on inpatient expenditure for rural population: the Sanming model in China. BMC Health Serv Res. 2019;19(1):231. doi: 10.1186/s12913-019-4048-7.
15. Yang J, Hong Y, Ma S. Impact of the new health care reform on hospital expenditure in China: A case study from a pilot city. China Economic Review. 2016;39:1-14. doi: 10.1016/j. chieco.2016.03.005 .
16. Alipour V, Pourreza A, Koosheshi M, Heydari H, Emamgholipour Sefiddashti S, Rahimi Foroushani A. Ageing and inpatient hospital expenditures: A study of steepening. Med J Islam Repub Iran. 2018;32:70. doi: 10.14196/mjiri.32.70.
17. Sanwald A, Theurl E. Out-of-pocket payments in the Austrian healthcare system - a distributional analysis. Int J Equity Health. 2015;14:94. doi: 10.1186/s12939-015-0230-7.
18. Toor IA, Butt MS. Determinants of health care expenditure in Pakistan. Pakistan Economic and Social Review. 2005:133-50.
19. Shahraki M, Agheli L, Assari Arani A, Sadeqi H, Ghaderi S. The relationship between mother’s socioeconomic status and child health. Journal of Research and Health. 2018;8(2):143-51.
20. Shahraki M, Agheli L, Arani AA, Sadeghi H. The effect of mothers’ education and employment on children’s health. Jentashapir Journal of Health Research. 2016;7(4):e30977. doi: 10.17795/jjhr-30977 .
21. Keshavarz Haddad G. Microeconometric data analysis and policy assessment. Tehran: Ney. 2015:90-112. Persian
22. Lee MJ. Micro-Econometrics: Methods of Moments and Limited Dependent Variables. New York: Springer; 2010.
23. Panahi H FF, Mohammadzadeh P, Janati A, Narimani MR, Sabaghizadeh L. Factors Influencing the Out -of-Pocket Payments by
Patients in the Hospital in Tabriz-Iran. Health Inf Manage. 2014;11(2):199-207. Persian.
24. Morgan S, Cunningham C. Population aging and the determinants of healthcare expenditures: the case of hospital, medical and pharmaceutical care in british columbia, 1996 to 2006. Healthc Policy. 2011;7(1):68-79. doi: 10.12927/hcpol.2011.22525 .
25. Caley M, Sidhu K. Estimating the future healthcare costs of an aging population in the UK: expansion of morbidity and the need for preventative care. J Public Health (Oxf). 2011;33(1):117-22. doi: 10.1093/pubmed/fdq044.
26. Su TT, Kouyate B, Flessa S. Catastrophic household expenditure for health care in a lowincome society: a study from Nouna District, Burkina Faso. Bull World Health Organ. 2006;84(1):21-7. doi: 10.2471/blt.05.023739.
27. Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Nabukhonzo P, et al. Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc Sci Med. 2006;62(4):866-76. doi: 10.1016/j. socscimed.2005.07.004.
28. Hosseini Nasab E, Varahrami V. Determinant factors on households health care expenditures in Yazd, Iran. Journal of Health Administration. 2010;13(40):73-9.
29. Arendt JN. In sickness and in health—till education do us part: Education effects on hospitalization. Economics of Education review. 2008;27(2):161-72.
30. Dursun B, Cesur R, Mocan N. The Impact of Education on Health Outcomes and Behaviors in a Middle-Income, Low-Education Country. Econ Hum Biol. 2018;31:94-114. doi: 10.1016/j.ehb.2018.07.004.
31. Shahraki M, Ghaderi S. The Relationship between Education and Health: Vector Error Correction Model (VECM). Journal of Health. 2019;10(4):445-56. Persian.
32. Yang C, Cai W, Li Z, Fang Y. Disparities in out-of-pocket inpatient expenditures in rural Shaanxi Province, western China from 2011 to 2014: a time series analysis. Trop Med Int Health. 2018;23(6):661-7. doi: 10.1111/tmi.13060.
Health Management & Information Science
Volume 7, Issue 2
April 2020
Pages 76-83

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