title: Hospitalization and catastrophic medical payment: evidence from hospitals located in Tehran.
abstract: BACKGROUND
  Hospitalized patients constitute the main fraction of users in any health system. Financial burden of reimbursement for received services and cares by these users is sometimes unbearable and may lead to catastrophic medical payments. So, designing and implementing effective health prepayments schemes appear to be an effective governmental intervention to reduce catastrophic medical payments and protect households against it. We aimed to calculate the proportion of hospitalized patients exposed to catastrophic medical payments, its determinant factors and its distribution.
  
  
  METHODS
  We conducted a cross sectional study with 400 samples in five hospitals affiliated with Tehran University of Medical Sciences (TUMS). A self-administered questionnaire was distributed among respondents. Data were analyzed by logistic regression and χ(2) statistics. Also, we drew the Lorenz curve and calculated the Gini coefficient in order to present the distribution of catastrophic medical payments burden on different income levels.
  
  
  RESULTS
  About 15.05% of patients were exposed to catastrophic medical payments. Also, we found that the educational level of the patient's family head, the sex of the patient's family head, hospitalization day numbers, having made any out of hospital payments linked with the same admission and households annual income levels; were linked with a higher likelihood of exposure to catastrophic medical payments. Also, the Gini coefficient is about 0.8 for catastrophic medical payments distribution.
  
  
  CONCLUSIONS
  There is a high level of catastrophic medical payments in hospitalized patients. The weakness of economic status of households and the not well designed prepayments schemes on the other hand may lead to this. This paper illustrated a clear picture for catastrophic medical payments at hospital level and suggests applicable notes to Iranian health policymakers and planners.
authors: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. arashidian@tums.ac.ir.
authors: Hesam
authors: H
authors: Ghiasvand
authors: Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Hossein
authors: H
authors: Sha'baninejad
authors: Department of Health Management and Economics, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Mohammad
authors: M
authors: Arab
authors: Department of Health Management and Economics, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Arash
authors: A
authors: Rashidian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006761:Hospitals; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007492:Iran; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D012737:Sex Factors; D055815:Young Adult