Determinants of utilization and out-of-pocket payments for psychiatric healthcare in Iran
| Pages | 127-134 |
| Published date | 09 September 2019 |
| DOI | https://doi.org/10.1108/JPMH-03-2019-0036 |
| Date | 09 September 2019 |
| Author | Enayatollah Homaie Rad,Leyla Amirbeik,Mohammad Hajizadeh,Shahrokh Yousefzadeh-Chabok,Zahra Mohtasham-Amiri,Satar Rezaei,Anita Reihanian |
| Subject Matter | Health & social care,Mental health,Public mental health |
Determinants of utilization and
out-of-pocket payments for
psychiatric healthcare in Iran
Enayatollah Homaie Rad, Leyla Amirbeik, Mohammad Hajizadeh, Shahrokh
Yousefzadeh-Chabok, Zahra Mohtasham-Amiri, Satar Rezaei and Anita Reihanian
Abstract
Purpose –Mental health is an inevitable and vital dimension when it comes to providing a global
definition for the appropriate health status. This highlights the importance of investigating factors
influencingutilization and out-of-pocket payments(OOP) for mental health services. Thus, thepurpose of
this paperis to assess the determinants of the utilizationand OOP for psychiatric healthcarein Iran.
Design/methodology/approach –A total of 39,864 households were included in this cross-sectional
study. Data on the utilization and OOP for psychiatric healthcare as well as all their determinants (e.g.
wealth indexof households, geographical area, householdsize, etc.) were extracted from the Household
Incomeand Expenditure Survey (HIES). The HIES was conductedby the Statistical Center of Iran in 2016.
A zero-inflated Tobit model was used to identify the main factors affecting utilization and OOP for
psychiatrichealthcare utilization.
Findings –The average of utilization and OOP for psychiatric services was found to be 14.67 times per
1,000 households and $7.783 per month for service users, respectively. There were significant positive
relationships between income and utilization (p¼0.0002) and OOP (p<0.0001) for psychiatric services.
Significant negative associations were found between the number of illiterate people in the household and
OOP (coefficient ¼1.56) and utilization(coefficient ¼0.2002) for psychiatric services. Utilization and OOP
for psychiatric services were statistically significantly higher among households with hi gher wealth status.
Originality/value –Despite the higher rate of mental disorders,the utilization of psychiatric services in
Iran is very low. Dueto financial barriers and insufficient insurancecoverage, high socioeconomic status
(SES) households utilize more psychiatric services than low-SES households. Thus, the integration of
mental health services in public health programs is required to improve the utilization of psychiatric
servicesin Iran.
Keywords Iran, Healthcare utilization
Paper type Research paper
Introduction
The World Health Organization(WHO) introduced the slogan of “Investing in Health” in 2007
to attract global attention to the issueof international security of health, and raise awareness
among politicians and governments as well as the general public to the issues related to
payments for health services (Eastern Mediterranean Region Mental Health Collaborators
GBD, 2018). Providing public health is the responsibility of the government. In spite of all
the efforts made by the Government in Iran, the health sector still faces several challenges
and Iranians still have difficulties in financing their expensive healthcare costs (Eastern
Mediterranean Region Mental HealthCollaborators GBD, 2018).
The percentage share of total health expenditures from the total gross domestic
production (GDP) in Iran increased from 5.24 percent in 2000 to 7.59 percent in 2015
Enayatollah Homaie Rad is
based at the Social
Determinants of Health
Research Center, Guilan
University of Medical Sciences,
Rasht, Islamic Republic of Iran.
Leyla Amirbeik is based at the
Student Research Committee,
Social Determinants of Health
Research Center, Guilan
University of Medical Sciences,
Rasht, Islamic Republic of Iran.
Mohammad Hajizadeh is based
at School of Health
Administration, Faculty of
Health, Dalhousie University,
Halifax, Canada. Shahrokh
Yousefzadeh-Chabok and
Zahra Mohtasham-Amiri are
both based at the Guilan Road
Trauma Research Center,
Guilan University of Medical
Sciences, Rasht, Islamic
Republic of Iran. Satar Rezaei
is based at the Kermanshah
University of Medical Sciences,
Kermanshah, Islamic Republic
of Iran. Anita Reihanian is
based at the Social
Determinants of Health
Research Center, Guilan
University of Medical Sciences,
Rasht, Islamic Republic of Iran.
Received 25 March 2019
Revised 8 June 2019
6 August 2019
Accepted 9 August 2019
DOI 10.1108/JPMH-03-2019-0036 VOL. 19 NO. 2 2020,pp. 127-134, ©Emerald Publishing Limited, ISSN 1746-5729 jJOURNAL OF PUBLIC MENTAL HEALTH jPAGE 127
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