Iranian Journal of

financial protection against health expenditures is a major goal of health system policymaking. governments have focused on the risk that high health expenditures pose to the financial security of deprived and vulnerable populations. Health systems need to be sure that people receive health services and are protected from the financial burden of health costs. There is no accepted standard for measuring the degree of financial protection. In the literature, there are different approaches to measure the degree of financial protection. Measuring the extent of financial risk is complicated by the fact that the significance of a given risk depends on both the size of the risk and the economic status of the person incurring the risk. Another reason for this complication is that financial risk can also affect the health status. The seriously ill may not receive adequate care if the financial burden on them contributes to a decision not to seek care. Their injury from a lack of risk protection, therefore, may show up as diminished health status and not as a financial loss. The aim of this article is to provide the methodology of the assessment of financial protection against health costs with focus on catastrophic health expenditures. First, we describe and explaine the methodology of measuring the expenditures (based on the WHO approach). Then, we interpret variables used in estimating these costs. Finally, overall discussion and conclusions will be provided in relation to the subject.

Background and Objectives: Catastrophic health expenditure (CHE) is a key indicator for measuring  households' financial protection in the health system. This study was conducted to measure the incidence and intensity of CHE in Iranian provinces 2008-2014.

Methods: When the out-of-pocket (OOP) spending of each household amounts to at least 40% of the household's capacity to pay, it is called a catastrophe. The incidence of CHE in Iranian provinces was estimated using the data obtained from household-expenditure-and-income-surveys. The intensity was calculated as the average extent to which OOPs exceeded the 40% threshold. Descriptive statistics and Mann-WhitneyU test were used for data analysis. The index of disparity(ID) was also calculated for geographical disparities across the provinces.

Results: On average, the lowest and highest CHE incidence and intensity were seen in Fars and South Khorasan provinces respectively. However, the highest and lowest rate for CHE households that actually experienced catastrophe at the 40% threshold belonged to Fars and Kurdistan provinces. The incidence of CHE in rural was more than urban areas. ID of CHE incidence for targeted amount was high and had no constant trend.

Conclusion: CHE incidence had a remarkable difference in different provinces and in the rural area compared to the urban area. Due to the importance of this index in promoting health financial protection, like indexes such as OOP, its distribution in rural and urban areas as well as in different provinces is considerable. It requires a structured format to identify the disadvantaged and low-income groups and provide financial-support and insurance for them.