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      Out of Pocket Payment for Obstetrical Complications: A Cost Analysis Study in Iran

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          Abstract

          Background:

          This study was conducted to determine the total expenditure and out of pocket payment on pregnancy complications in Tehran, the capital of Iran.

          Methods:

          A cross-sectional study conducted on 1172 patients who admitted in two general teaching referral Hospitals in Tehran. In this study, we calculated total and out of pocket inpatient costs for seven pregnancy complications including preeclampsia, intrauterine growth restriction (IUGR), abortion, ante-partum hemorrhage, preterm delivery, premature rupture of membranes and post-dated pregnancy. We used descriptive analysis and analysis of variance test to compare these pregnancy complications.

          Results:

          The average duration of hospitalization was 3.28 days and the number of visits by physicians for a patient was 9.79 on average. The average total cost for these pregnancy complications was 735.22 Unites States Dollars (USD) (standard deviation [SD] = 650.53). The average out of packet share was 277.08 USD (SD = 350.74), which was 37.69% of total expenditure. IUGR with payment of 398.76 USD (SD = 418.54) (52.06% of total expenditure) had the greatest amount of out of pocket expenditure in all complications. While, abortion had the minimum out of pocket amount that was 148.77 USD (SD = 244.05).

          Conclusions:

          Obstetrics complications had no catastrophic effect on families, but IUGR cost was about 30% of monthly household non-food costs in Tehran so more financial protection plans and insurances are recommended for these patients.

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          Most cited references21

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          Socioeconomic inequality in infant mortality in Iran and across its provinces.

          Reza Majdzadeh, Mohsen Naghavi, Angelica Sousa … (2005)
          To measure the socioeconomic inequality in infant mortality in Iran (the Islamic Republic of Iran). We analysed data from the provincially representative Demographic and Health Survey, which was done in Iran in 2000. We used a dichotomous hierarchical ordered probit model to develop an indicator of socioeconomic status of households. We assessed the inequality in infant mortality by using the odds ratio of infant mortality between the lowest and highest socioeconomic quintiles at both the provincial and national levels, and the concentration index, an inequality measure based on the entire socioeconomic distribution. We found a decreasing trend in the infant mortality rate in relation to socioeconomic quintiles. The poorest to richest odds ratio was 2.34 (95% CI = 1.78-3.09). The concentration index of infant mortality in Iran was -0.1789 (95% CI = -0.2193--0.1386). Furthermore, the inequality of infant mortality between the lowest and highest quintiles was significant and favoured the better-off in most of the provinces. However, this inequality varied between provinces. Socioeconomic inequality in infant mortality favours the better-off in the country as a whole and in most of its provinces, but the degree of this inequality varies between the provinces. As well as its national average, it is important to consider the provincial distribution of this indicator of population health.
          Article 0 comments Cited 31 times – based on 0 reviews     Review now
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            Health insurance and treatment seeking behaviour: evidence from a low-income country.

            Matthew Jowett, Anil B. Deolalikar, Peter Martinsson (2004)
            This paper analyses the effect of being insured under the voluntary component of Vietnamese Health Insurance, on patterns of treatment seeking behaviour. A multinomial logit model is estimated using household survey data from three provinces in Vietnam. Decisions regarding both the type of provider sought and type of care received are analysed. Insurance status is treated as both exogenous and endogenous to account for potential selection bias. The results indicate that, overall, insured patients are more likely to use outpatient facilities, and public providers, an effect that is particularly strong at lower income levels.
            Article 0 comments Cited 29 times – based on 0 reviews     Review now
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              Out-of-pocket and informal payments in health sector: evidence from Georgia.

              George Gotsadze, Helen Shahriari, Paolo Belli (2004)
              This study presents an in-depth investigation of out-of-pocket payments for health services, formal and informal, in the Republic of Georgia. The main purpose of the study is to: (a) analyze the process of collection and distribution of out-of-pocket or direct payments and particularly of the informal component; (b) explain why they seem to be so prevalent; (c) investigate their consequences, especially on access and quality of health care services. The findings of this study are derived from in-depth interviews and focus group discussions with users as well as providers. The study found that in general paying for health services in Georgia has become a really common and mostly accepted practice, and that a significant share of these payments are completely unrecorded. The extent of direct payments for health services are producing severe consequences on both equity and efficiency, making services unaffordable for most people, and leading to under funding of essential inputs. The policy implications of the study findings are challenging. First, the study clearly points out the deep-rooted and multidimensional reasons why out-of-pocket payments are pervasive, and why an important share of them is collected informally. Second, the study highlights that there is no simple solution. In particular, some of the solutions frequently proposed in the international debate, such as simply formalizing user charges, in the Georgian context appear impractical.
              Article 0 comments Cited 28 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Prev Med
                Journal ID (iso-abbrev): Int J Prev Med
                Journal ID (publisher-id): IJPVM
                Title: International Journal of Preventive Medicine
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2008-7802
                ISSN (Electronic): 2008-8213
                Publication date (Print): November 2013
                Volume: 4
                Issue: 11
                Pages: 1296-1303
                Affiliations
                [1]Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and Department of Gynecology, Hamedan University of Medical Sciences, Hamedan, Iran
                [1 ]Department of Community Medicine, Social Determinants of Health Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [2 ]Department of Community Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence to: Dr. Mohammad Reza Sohrabi, Department of Community Medicine, Social Determinants of Health Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, P.O. Box 193954719, Evin, Tehran, Iran. E-mail: m.sohrabi@ 123456sbmu.ac.ir
                Article
                Publisher ID: IJPVM-4-1296
                PMC ID: 3883255
                PubMed ID: 24404365
                SO-VID: b5b4efb7-71ed-4426-b724-7c4f7eef9865
                Copyright © Copyright: © International Journal of Preventive Medicine
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 December 2012
                Date accepted : 14 May 2013
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Health & Social care
                Keywords: cost and cost analysis,inpatients,iran,pregnancy complications,tehran
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: cost and cost analysis, inpatients, iran, pregnancy complications, tehran

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