title: Health Expenditure and Catastrophic Costs for Inpatient- and Out-patient Care in Iran.
abstract: BACKGROUND
  Protecting households from risk of impoverishment due to out-of-pocket costs in health care is a major challenge for health systems. Therefore, this study aimed at evaluating some health expenditure of inpatient and outpatient care as well as assessing the predictors of catastrophic costs for inpatient care in one of central provinces of Iran.
  
  
  METHODS
  In this cross-sectional study, 760 household were selected by multistage sampling method in Markazi province of Iran and interviewed in order to complete a standard questionnaire. Catastrophic costs were evaluated in a scale that varied from 0 (no money for care) to 100 (spending all income and wealth). Patients who were paid over 20% of household financial sources or 40% of month income were regarded as being exposed to catastrophic costs. Negative binomial model with robust estimator logit function was used for prediction of catastrophic costs.
  
  
  RESULTS
  Based on data analysis, 42.6% of hospitalized subjects encountered catastrophic costs. Moreover, 11.2% households faced catastrophic cost among all participated households and 39.3% were reported to need inpatient need care. Multivariate regression model showed that age range 40-59 years and being in the lower levels of wealth index were significant predictors of facing catastrophic costs (P < 0.05).
  
  
  CONCLUSIONS
  Lack of money is the most important cause of un-seeking care. Hospitalizations due to inpatient care needs, household members aged 40-59 years old, especially with chronic diseases and nonrich status of the household were the highest predictors of facing catastrophic costs. Reducing out-of-pocket costs can increase health care utilization.
authors.affiliation: Department of Education Development Center, Arak University of Medical Sciences, Arak, Iran.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Anbari
authors.affiliation: Department of Epidemiology and Biostatistics, School of Health, Qom University of Medical Sciences, Qom, Iran ; Health Policy and Promotion Research Center, Qom, Iran.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Mohammadbeigi
authors.affiliation: Health Policy and Promotion Research Center, Qom, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Mohammadsalehi
authors.affiliation: Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ebrazeh
keywords: Catastrophic costs; health expenditures; inpatient care; negative binomial model; outpatient care