Exploring dental and medicine health expenditures in Iran: financial protection and inequality analysis.

Abstract

Background: Healthcare systems must not only improve health outcomes but also protect individuals from financial hardship caused by healthcare costs. This study aimed to investigate financial protection and economic inequality in catastrophic dental healthcare expenditure (CDHE) and catastrophic medicine expenditure (CME) among the insured households through the Social Security Organization (SSO) in Iran.

Method: This cross-sectional study gathered data from 1679 insured households across 5 provinces, utilizing a multistage sampling approach. The prevalence of CDHE and CME was assessed by determining the proportion of households spending at least 40% of their capacity to pay on dental care and medications. Logistic regression analysis was used to identify the factors contributing to CDHE and CME. The concentration curve (CC) and concentration index (CI) were employed to visualize and quantify the extent of economic inequality in CDHE and CME. The CI was further decomposed to identify the primary factors driving the observed economic inequality in CDHE and CME.

Findings: The study found that 6.2% (95% confidence interval CI 5.1 to 7.4%) of households experienced CDHE and 4.9% (95% CI 4.0 to 6.0%) experienced CME. The CI for dental costs and medication costs were 0.248 (95% CI 0.115 to 0.381) and was 0.149 (95%CI 0.087 to 0.211), respectively, indicating that these costs were more concentrated among socioeconomically advantaged households. Conversely, the CI for CDHE and CME were -0.185 (95% CI -0.297 to -0.073) and -0.570 (95% CI -0.692 to -0.448), respectively, suggesting that these outcomes were more prevalent among poorer households. The decomposition analysis highlighted that the household wealth index explained 45.4% and 22.5% of the concentration of CDHE and CME among the poor, respectively.

Conclusion: The financial burden imposed by out-of-pocket (OOP) payments for dental care and medication was substantial among households insured by the SSO. Expanding insurance coverage for these services could significantly reduce OOP spending and the likelihood of health expenditures leading to poverty, particularly among lower-income households.