Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality

Bakhtiar Piroozi,1 Amjad Mohamadi-Bolbanabad,1 Ghobad Moradi,1 Hossein Safari,2 Shahnaz Ghafoori,1 Yadolah Zarezade,1 Farzam Bidarpour,1 Satar Rezaei3 1Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran;...

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Autores principales:	Piroozi B, Mohamadi-Bolbanabad A, Moradi G, Safari H, Ghafoori S, Zarezade Y, Bidarpour F, Rezaei S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	catastrophic cost diabetes inequalities socioeconomic status Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/bdde4dd14fc7435a87b44f5e3ad92929
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spelling	oai:doaj.org-article:bdde4dd14fc7435a87b44f5e3ad929292021-12-02T08:42:49ZIncidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality1178-7007https://doaj.org/article/bdde4dd14fc7435a87b44f5e3ad929292020-08-01T00:00:00Zhttps://www.dovepress.com/incidence-and-intensity-of-catastrophic-health-care-expenditure-for-ty-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Bakhtiar Piroozi,1 Amjad Mohamadi-Bolbanabad,1 Ghobad Moradi,1 Hossein Safari,2 Shahnaz Ghafoori,1 Yadolah Zarezade,1 Farzam Bidarpour,1 Satar Rezaei3 1Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran; 2Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran; 3Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Satar RezaeiResearch Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranEmail satarrezaei@gmail.comBackground: The present study aimed to assess the prevalence and intensity of catastrophic health-care expenditures (CHE) relating to type 2 diabetes mellitus care and inequality in facing such expenditures in Iran.Methods: A total of 1065 type 2 diabetes patients were included in this cross-sectional study. A multistage sampling method was used to select the samples. Data on sociodemographic characteristics, economic status, health and diabetic costs were collected using a self-constructed questionnaire. We used capacity to pay (CTP) of households to calculate the incidence of CHE due to diabetic care at four different thresholds. The mean positive overshoot (MPO) and overshoot were used to assess the intensity of CHE. The relative concentration index and slope index of inequality (SII) were used to measure socioeconomic-related inequalities in incidences of CHE. In addition, decomposition methods were used to identify the main factors affecting observed inequality in CHE.Results: The incidence of CHE at the 10, 20, 30, and 40% of CTP thresholds for type 2 diabetes mellitus care was 57.5, 28.9, 16.5, and 11.4%, respectively. The results of CI and SII indices for CHE due to diabetic care indicated that the incidence of CHE was more prevalent among patients with lower socioeconomic groups. The decomposition analysis showed that the socioeconomic status, marital status and gender of patients were the main factors contributing to socioeconomic inequality in incidence of CHE among the poor.Conclusion: Our study demonstrated that the incidence and intensity of CHE due to diabetic care were relatively high, particularly among socioeconomically disadvantaged patients. Modification to the present health care financing strategies is recommended in order to protect lower socioeconomic groups against the financial burden of diabetic care.Keywords: catastrophic cost, diabetes, inequalities, socioeconomic statusPiroozi BMohamadi-Bolbanabad AMoradi GSafari HGhafoori SZarezade YBidarpour FRezaei SDove Medical Pressarticlecatastrophic costdiabetesinequalitiessocioeconomic statusSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 13, Pp 2865-2876 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	catastrophic cost diabetes inequalities socioeconomic status Specialties of internal medicine RC581-951
spellingShingle	catastrophic cost diabetes inequalities socioeconomic status Specialties of internal medicine RC581-951 Piroozi B Mohamadi-Bolbanabad A Moradi G Safari H Ghafoori S Zarezade Y Bidarpour F Rezaei S Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality
description	Bakhtiar Piroozi,1 Amjad Mohamadi-Bolbanabad,1 Ghobad Moradi,1 Hossein Safari,2 Shahnaz Ghafoori,1 Yadolah Zarezade,1 Farzam Bidarpour,1 Satar Rezaei3 1Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran; 2Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran; 3Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Satar RezaeiResearch Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranEmail satarrezaei@gmail.comBackground: The present study aimed to assess the prevalence and intensity of catastrophic health-care expenditures (CHE) relating to type 2 diabetes mellitus care and inequality in facing such expenditures in Iran.Methods: A total of 1065 type 2 diabetes patients were included in this cross-sectional study. A multistage sampling method was used to select the samples. Data on sociodemographic characteristics, economic status, health and diabetic costs were collected using a self-constructed questionnaire. We used capacity to pay (CTP) of households to calculate the incidence of CHE due to diabetic care at four different thresholds. The mean positive overshoot (MPO) and overshoot were used to assess the intensity of CHE. The relative concentration index and slope index of inequality (SII) were used to measure socioeconomic-related inequalities in incidences of CHE. In addition, decomposition methods were used to identify the main factors affecting observed inequality in CHE.Results: The incidence of CHE at the 10, 20, 30, and 40% of CTP thresholds for type 2 diabetes mellitus care was 57.5, 28.9, 16.5, and 11.4%, respectively. The results of CI and SII indices for CHE due to diabetic care indicated that the incidence of CHE was more prevalent among patients with lower socioeconomic groups. The decomposition analysis showed that the socioeconomic status, marital status and gender of patients were the main factors contributing to socioeconomic inequality in incidence of CHE among the poor.Conclusion: Our study demonstrated that the incidence and intensity of CHE due to diabetic care were relatively high, particularly among socioeconomically disadvantaged patients. Modification to the present health care financing strategies is recommended in order to protect lower socioeconomic groups against the financial burden of diabetic care.Keywords: catastrophic cost, diabetes, inequalities, socioeconomic status
format	article
author	Piroozi B Mohamadi-Bolbanabad A Moradi G Safari H Ghafoori S Zarezade Y Bidarpour F Rezaei S
author_facet	Piroozi B Mohamadi-Bolbanabad A Moradi G Safari H Ghafoori S Zarezade Y Bidarpour F Rezaei S
author_sort	Piroozi B
title	Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality
title_short	Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality
title_full	Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality
title_fullStr	Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality
title_full_unstemmed	Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality
title_sort	incidence and intensity of catastrophic health-care expenditure for type 2 diabetes mellitus care in iran: determinants and inequality
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/bdde4dd14fc7435a87b44f5e3ad92929
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Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality

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