Assessing Catastrophic Health Expenditure among Iraqi Households: A Cross-Sectional Study
,
Abstract
Background: Catastrophic health expenditures can lead to severe household financial burdens, exacerbating poverty and limiting access to necessary health services. This study examined the prevalence and determinants of catastrophic health expenditures among households in six provinces of Iraq.
Methods: A cross-sectional design was employed, gathering data from 2,400 households in Baghdad, Wasit, Karbala, An-Najaf, Babil, and Maysan in 2023. A two-stage cluster sampling method was utilized, selecting 400 households from each province. Data were collected using WHO "World Health Survey" questionnaire, focusing on health expenditures and household income. Catastrophic health expenditures as defined as out-of-pocket costs exceeding 40% of a household’s capacity to pay. Statistical analyses, including logistic regression with calculating adjusted odds ratio, were performed using STATA14 software.
Results: Overall, 246 households (12.6%) faced Catastrophic health expenditures, with a higher prevalence among female heads of households (13.1%) compared to males (12.6%). The multivariate logistic regression analysis indicated that households with 4 to 6 members had 1.52 times higher odds of facing catastrophic health expenditures (AOR=1.52, CI: 1.06 to 2.20). Furthermore, the poorest households had an AOR of 95.28 for experiencing catastrophic health expenditures (OR=95.28, CI: 13.12 to 691.49).
Conclusion: This study underscores the urgent need for tailored policies to reduce the impact of CHE on Iraqi households. By improving access to healthcare and promoting equitable health insurance enrollment, policymakers can alleviate financial strain and support the health and well-being of vulnerable communities.
2. Flores G, Hsu J, Smitz M-F, Chepynoga K (2018). Progress on catastrophic health spending in 133 countries: a retrospective observational study. Lancet Glob Health, 6(2):e169–e79.
3. Neelsen S (2020). A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study. Lancet Glob Health, 8(1):e39-e49.
4. World Health Organization (2016). World Health Statistics 2016 [OP]: Monitoring Health for the Sustainable Development Goals (SDGs). World Health Organization.
5. Vahedi S, Rezapour A, Faraji Khiavi F, et al (2020). Decomposition of Socioeconomic Inequality in Catastrophic Health Expenditure: An Evidence from Iran. Clin Epidemiol Glob Health, 8(2):437-41.
6. Zhao S-w, Zhang X-y, Dai W, et al (2020). Effect of the catastrophic medical insurance on household catastrophic health expenditure: evidence from China. Gac Sanit, 34(4):370-6.
7. Piroozi B, Moradi G, Nouri B, et al (2016). Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran. Int J Health Policy Manag, 5(7):417-23.
8. Wagstaff Adam (2008). Measuring financial protection in health: The world Bank.
9. Kavosi Z, Delavari H, Keshtkaran A, et al (2014) Catastrophic health expenditures and coping strategies in households with cancer patients in Shiraz Namazi hospital. Middle East J Cancer, 5(1):13-22.
10. Xu K, Evans DB, Kawabata K, et al (2003). Household catastrophic health expenditure: a multicountry analysis. Lancet, 362(9378):111-7.
11. Kavosi Z, Rashidian A, Pourreza A, et al (2012). Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan, 27(7):613-23.
12. Hajizadeh M, Nghiem HS (2011). Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments? Int J Health Care Finance Econ, 11(4):267-85.
13. World Health Organization (2023). Universal Health Coverage Partnership annual report 2022: more than 10 years of experiences to orient health systems towards primary health care. World Health Organization.
14. World Health Organization (2023). Tracking universal health coverage: 2023 global monitoring report. World Health Organization.
15. World Health Organization (2023). Strengthening primary health care as a key element towards achieving universal health coverage. World Health Organization.
16. Elgazzar H, Arfa C, Salti N, et al (2013). Who pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North Africa. World Bank. Washington, DC.
17. Alami R (2017). Health Financing Systems, Health Equity and Universal Health Coverage in Arab Countries. Dev Change, 48(1):146-79.
18. Jakovljevic M, Pallegedara A, Vinayagathasan T, Kumara AS (2022). Inequality in healthcare utilization and household spending in developing countries. Front Public Health, 10:970819.
19. Al Janabi T, Chung S (2022). Current impact and long-term influence of the COVID-19 pandemic on Iraqi healthcare systems: a case study. Epidemiologia (Basel), 3(4):412–33.
20. Puente-López JL, Lis-Gutiérrez JP, Pulido-Flórez JS (2022). The Legatum Prosperity Index and non-cooperative tax jurisdictions (2021). Procedia Computer Science, 203:514–9.
21. National Academies of Sciences, Medicine Division, Board on Global Health and Committee on the Evaluation of Strengthening Human Resources for Health Capacity in the Republic of Rwanda Under the President's Emergency Plan for AIDS Relief (PEPFAR) (2020). Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. National Academies Press.
22. Thakur B, Pathak M (2022). Utilization of healthcare services for children in low and middle-income countries: Its determinants and child health outcomes. Front Pediatr, 10:1014775.
23. World Health Organization (2010). World health statistics 2010. World Health Organization.
24. Russell S (2004). The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. Am J Trop Med Hyg, 71(2 Suppl):147-55.
25. Marmot M, Bell R (2018). The sustainable development goals and health equity. Epidemiology, 29(1):5-7.
26. Giles-Corti B, Lowe M, Arundel J (2020). Achieving the SDGs: Evaluating indicators to be used to benchmark and monitor progress towards creating healthy and sustainable cities. Health Policy, 124(6):581-90.
27. Ahmadnezhad E, Dastan I, Alvandi R, Abdi Z (2023). The impact of health reform on poverty estimates in Iran: Implications for monitoring the first goal of Sustainable Development Goals. Int J Health Plann Manage, 38(3):747-758.
28. Mabry RM, Doctor HV, Khair MNN, et al (2024). Integrating health across the Sustainable Development Goals in the Eastern Mediterranean Region: Assessment of Voluntary National Reviews from 18 countries. PLOS Glob Public Health, 4(7):e0003451.
29. Mabry RM, Doctor HV, Khair MN, et al (2024). Measuring progress on health and well-being in the Eastern Mediterranean Region via voluntary national reviews, 2016-2021: What does the data reveal? PLOS Glob Public Health, 4(7):e0002838.
30. Subramanian SV, Ambade M, Kumar A, et al (2023). Progress on Sustainable Development Goal indicators in 707 districts of India: a quantitative mid-line assessment using the National Family Health Surveys, 2016 and 2021. Lancet Reg Health Southeast Asia, 13:100155.
31. Lim SS, Allen K, Bhutta ZA, et al (2016). Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. Lancet, 388(10053):1813-50.
32. World Health Organization (2015). Health in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals. World Health Organization.
| Files | ||
| Issue | Vol 54 No 6 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Catastrophic health expenditures (CHE) Health system Iraq | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
