Catastrophic health expenditures and impoverishment in the households receiving expensive interventions before and after health sector evolution plan in Iran: Evidence from a big hospital

Introduction: Household financial contribution (HFC) in health is one of the most important goals of health systems. The purpose of this study was to compare the exposure of households to catastrophic health expenditures and impoverishment before and after the health sector evolution (HSE) plan in Iran in a big governmental Hospital. Materials and Methods: This study investigates the households with hospitalization history in public and tertiary referral hospital, CHE is calculated using representative data from Households receiving expensive interventions in the imam Reza hospital. Data related to treatment expenditures were obtained from Hospital Information System (HIS) and data related to households’ food and non-food expenditures were obtained using questionnaire in expenditure-income survey of Iran’s Statistics Center as well as phone calls to the households. Households who had dedicated ≥40% of their Capacity to Pay (CTP) to health expenditures experienced catastrophic health expenditures. Results: Exposure to catastrophic health expenditures in the households decreased from 81.1% before the implementation of HSE to 66.7% after the implementation of HSE (p<0.001). Exposure of households to poverty, due to participation in health expenditures, decreased from 41.3% to 29.4% (p<0.001). Conclusion: Exposure of households receiving expensive interventions to catastrophic expenditures and impoverishment is decreased. The findings of this study can be generalized to similar hospitals. At the same time, more comprehensive studies with cost effectiveness analysis perspective can show the more aspects of HSE. Keywords: Catastrophic Health Expenditures, Impoverishment, Financial Contribution, Health Sector Evolution