Analysis Equity in Financing of Household's Health in Iran ( by Concentration and Extended Concentration Index)

##plugins.themes.bootstrap3.article.main##

  •   Ali Maher

  •   Zahra Fazel

Abstract

Health status of societies is among the basic indices of economic and social development and hence, investment in this section directly impacts on social welfare and economic growth. Low quality of health care and inequality in health care expenditure contributions can lead to different forms of social and economic consequences. This is the main concern of the public policy makers, in particular those who are engaged with health care services. Hence, monitoring households' health expenditures, which can reflect socio-economic inequality, can provide valuable information for the health policy makers.
The concentration index and the extended concentration index introduced by Wgstaff (2002) is used to estimate inequality in health expenditures of urban households. Also, the household’s expenditures in Iran are disaggregated into expenditure quintiles through selected years from 1989 (i.e. beginning of the development programs in Iran after the revolution) till 2014. To this end, Iran’s annual household’s survey data produced by Iran statistic center is used.
The concentration index has upward trend in 1989 to 2005, and after that it has fluctuating trend. Fifth quintile has the highest income inequality and the most inequality in health expenditures, because there are some households with high health expenditures in this group; while they are not rich in fact. The extended concentration index has been light fluctuation in the selected years. Increasing the extended concentration index represents the increasing inequalities in health expenditures, so increase in this indicator is a sign of the worsening health situation in the country.
Despite of the improvements in some key health indices such as the rate of maternal mortality, the under five years mortality, life expectancy of women and men, the findings of this study shows that the households' expenditure inequality increases in favor of the higher income groups, and on the other, the public policy in health has not been effective as expected. Moreover, the results of the study indicates that higher degree of inequality aversion parameter, the lower disparity between the average households' health expenditures and its average at the "perfect equality". This result shows that the capability of the individuals, and particularly the lower income groups, has been weakened.


Keywords: Health inequalities, health economics, health policy, inequality

References

B. Salehi, H. Solhi, A. R. Fotovat, D. Motamedi, SH. Moradi, and S. Ebrahimi, “The comparison of the psychiatric disorders between opium addicts' families referring to opium withdrawal clinics and nonaddicts' families referring to blood transmission centers.” Arak University of Medical Sciences Journal, vol.15 (3), pp. 32-8[Article in Persian]. 2012.

M. Yousefi, A. Assari Arani, B. Sahabi, and A. Kazemnejad, “Direct and indirect costs of household health expenditure,” Hospital, Vol. 12(4), pp. 51-61[Article in Persian]. 2014.

The world health report 2013: Research for universal health coverage. Geneva: World Health Organization, pp. 5-21.

Human Development Report 2003, UNDP, New York: Oxford University Press.

Planning and Budget Organization, First Human Development National Report of Islamic Republic of Iran. Planning and Budget Organization, Iran. Tehran, pp. 123-12. 1999.

A. Sen, Why Health Equity? In: S. Anand, F. Peter, A. sen, eds, Public Health Ethics and Equity, 1th ed, Oxford: Oxford University Press, 2004, pp.21-35.

M.R. Vaez-Mahdavi, Z. Vaez-Mahdavi, M.M. Araei, “The Impact of Social Policies on Human Development Following the 1979 Islamic Revolution in Iran,” International Journal of Healthcare, Insurance and Equity, Vol. 1, No. 2. 2013.

T. Moultrie, R. Dorrington, A. Hill, K. Hill, I. Timaeus, B. Zaba, “Tools for demographic estimation,” Paris: International Union for the Scientific Study of Population. 2013.

Development of indicators for monitoring progress towards health for all by the year 2000, World Health Organization. Geneva. 1981.

C.J.L. Murray, T. Laakso, K. Shibuya, K. Hill, A.D. Lopez. Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015, Lancet 2007, vol. 370(9592), pp.1040-1054

Panel UHL. Millennium development goals, 2013, (Report).

Available: https://www.unicef.org/iran/fa/, [in Persian].

H. Raghfar, S. Gholami, “Households’ Health Expenditure Inequality in Iran: 1984-2011,” Hakim Research Journal, vol. 16(4), pp. 302- 316 [Article in Persian]. 2014.

A. Case, D. Lubotsky, C. Paxson, Economic Status and Health in Childhood: The origins of gradient, American Economic Review 2002, vol. 92(5), pp. 1308-1334.

H. Graham, Introduction: The Challenge of Health Inequalities. In: Graham Hilary. Understanding Health Inequalities. 1th ed, New York: Mc Grow Hill Press, pp. 1-21, 2010.

D. Wagstaff, “Equity in the Finance of Health Care: Some International Comparisons,” Journal of Health Economics, vol. 11, pp.361-387. 1992.

M. Makinen, H. Waters, M. Rauch, N. Almagambetova, R. Bitran, L. Gilson, et al. “Inequalities in health care use and expenditure: empirical data from eight developing countries and countries in transition,” World Health Organization, vol. 78, pp. 55-65. 2000.

A.M. Jones, A.L. Nicolas, “Measurement and explanation of socioeconomic inequality in health with longitudinal data,” Health Econ. 13, pp. 1015–1030, 2004.

P.Y. Chai, D.K. Whynes, T.H. Sach. “Equity in health care financing: The case of Malaysia,” Bio Med Central, International Journal for Equity in Health 2008, vol. 7(15), pp. 1-14.

A. Wagstaff, E. van Doorslaer, P. Paci, “Equity in the finance and delivery of health care: Some tentative cross-country comparisons,” Oxford Review of Economic Policy 1989, vol. 5, pp. 89-112.

A. Wagstaff, “Inequality Aversion, Health Inequalities and Health Achievement,” Journal of Health Economics 2002, vol. 21, pp. 627-641.

N.C. Kakwani, A. Wagstaff, E. Van Doorslaer, “Socioeconomic inequalities in health: measurement, computation and statistical inference,” Journal of Econometrics 1997, vol. 77, pp. 87-103.

O. O’Donnell, E. Doorslaer, A. Wagstaff, M. Lindelow, Analyzing Health Equity Using Household Survey Data, The World Bank Institute.

H. Raghfar, N. Zargari, K. Sangari Mohazzab, “Measuring Inequality in Households’ Health Care Expenditures in Iran,” Hakim Research Journal 2013, vol. 16(2), pp. 89- 97[Article in Persian].

A. Moradi. Equity of health care financing: an application to Iran, [Cited 2011 Sep. 18]. Available: http://mpra.ub.uni-muenchen.de/33489/.

V. Mahdavi, M.R. Farshad Momeni, H. Raghfar, F. Heidary, “inequalities in the mirror of research,” Publishers of Shahed University, [Article in Persian]. 2009.

S.A.L. Marandi, “Social determinants of health,” Comprehensive public health book, Chapter 13, article 31, [Article in Persian]. 2006.

SH. Semnani, AA. Keshtkar, “Estimate of fairness of health care cost in the coverage area of population research base of Gorgan,” Journal of medical sciences of Gorgan university, issue 12, autumn and winter, pp. 9-53 [Article in Persian], 2003.

Downloads

Download data is not yet available.

##plugins.themes.bootstrap3.article.details##

How to Cite
Maher, A., & Fazel, Z. (2019). Analysis Equity in Financing of Household’s Health in Iran ( by Concentration and Extended Concentration Index). European Journal of Medical and Health Sciences, 1(1). https://doi.org/10.24018/ejmed.2019.1.1.18