Seyed Mohammad Reza Mousavi, Nader Makarzi Moghaddam, Hessamoddin Sharifnia Sharifnia, Maryam Vasheghani Farahani, Sanaz Zargar Balaye Jame,
Volume 19, Issue 6 (3-2026)
Background and Aim: Fair protection against financial risks is considered one of the main goals of health systems, and lack of financial protection in health is regarded as a disease in health systems. Protecting citizens from the financial consequences of illness and fair access to health services is a challenge for governments and policymakers. Therefore, this study was conducted to investigate the indicators of out-of-pocket payments (OOP), catastrophic health expenditures (CHE), and Impoverishing Health Expenditures in hospitals in Tehran.
Materials and Methods: This descriptive-analytical study was conducted cross-sectionally in 2023. The research population was all the households covered by one of the country’s insurance organizations in Tehran and 298 households participated in this study. A simple random sampling method was performed in five selected general hospitals in Tehran. The World Health Organization questionnaire was used to collect data. An interview was conducted with the head of the household or an informed person of the family. The back-breaking expenses were calculated based on the household’s payment capacity and the poverty line based on the household’s food expenses. Data were analyzed using Excel and SPSS software.
Results: The results showed that 39.9% of households spent less than 10% of their total household expenditures on OOP health payments. However, 62.1% and 24.2% of participants experienced CHE and impoverishing health expenditures, respectively. Additionally, 36.9% reported borrowing money from friends or family, while 17.4% borrowed from non-relatives to cover health expenses. Furthermore, 5.4% of participants were forced to sell household assets, such as furniture, carpets, or jewelry, to finance their healthcare costs. Dental services, with an average cost of 1369000 tomans (±3,626,000), and medications with an average cost of 1,210,000 tomans (±2,104,000), imposed the highest expenses on households. Statistical analyses showed that the prevalence of CHE among participants differed significantly according to age (P=0.001), employment status (P=0.004), presence of a disabled or care-dependent individual in the household (P=0.002), and education level (P=0.021).
Conclusion: According to the results of the study, over 62% of households face CHE, particularly among older adults and retirees, indicating weak financial protection in the health system. This highlights the urgent need to reform health financing policies and expand targeted insurance coverage for high-risk groups. It is recommended to design special insurance packages for individuals aged 60 and above, covering chronic, specialized, and preventive services.
