title: Inequality in household catastrophic health care expenditure in a low-income society of Iran.
abstract: BACKGROUND
  We assessed change in household catastrophic health care expenditures (CHE) and inequality in facing such expenditures in south-west Tehran.
  
  
  METHODS
  A cluster-sampled survey was conducted in 2003 using the World Health Survey questionnaire. We repeated the survey on the same sample in 2008 (635 and 603 households, respectively). We estimated the proportion of households facing CHE using the 'household's capacity to pay'. We identified the determinants of the household CHE using regression analysis and used the concentration index to measure socio-economic inequality and decompose it into its determinants factors.
  
  
  RESULTS
  Findings showed that the proportion of household facing CHE had no significant change in this period (12.6% in 2003 vs 11.8% in 2008). The key determinants of CHE for both years were health care utilization and health care insurance status. Socio-economic status was the main contributor to inequality in CHE, while unequal utilization of dentistry and outpatient services had reduced the inequality in CHE between socio-economic groups.
  
  
  CONCLUSIONS
  We observed no significant change in the CHE proportion despite policy interventions aimed at reducing such expenditures. Any solution to the problem of CHE should include interventions aimed at the determinants of CHE. It is essential to increase the depth of social insurance coverage by expanding the basic benefit package and reducing co-payments.
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Kavosi
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.forename: Abolghasem
authors.initials: A
authors.lastname: Pourreza
authors.forename: Reza
authors.initials: R
authors.lastname: Majdzadeh
authors.forename: Farshad
authors.initials: F
authors.lastname: Pourmalek
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Hosseinpour
authors.forename: Kazem
authors.initials: K
authors.lastname: Mohammad
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002388:Catastrophic Illness / Q000191:economics*; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage; D007354:Insurance, Major Medical; D007492:Iran; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011795:Surveys and Questionnaires; D055815:Young Adult