Ophthalmic Care Utilization and Out-of-Pocket Expenditure in Iran: Kurdistan Eye Health and Economics Survey-2015

Background: Due to lack of information about ophthalmic economics in Iran, health policy makers unable to distribute resources optimally in terms of efficiency and equity. Therefore, we estimated the total and eye care utilization, out-of-pocket expenditures, and its association with social determinants of health in Iran in 2015. Methods: A multi-stage population-based, cross-sectional study in a random sample aged 50 yr or older in Kurdistan Province, Northwest Iran was used. The utilization rate of eye and general health care and related out-of-pocket expenditures was estimated during the recent last six months. To find the association between social factors and care out-of-pocket expenditures, we used a Heckman two-step regression model. Results: About 81% and 37% of participants were utilized the health and ophthalmic services, respectively. Statistically significant lower ophthalmic utilization rates were observed among men, middle-aged population, illiterate participants, rural residents, daily-paid workers, and the poorest participants. The average of vision and total health-related out-of-pocket expenditures among those used these services have estimated as US$43.7 (SE: 2.6) and US$439.9 (SE: 22.8), respectively. The highest (US$ 396.6) and lowest (US$ 10.4) ophthalmic out-of-pocket costs were related to patients with Glaucoma and Central Nervous System abnormalities, respectively. Multivariate analyses confirmed an unequal probability of having the ophthalmic out-of-pocket expenditures among different subgroups especially in favor of females, older, and those with more severe visual impairment. Conclusion: Ophthalmic disorders reconstituted about 10% of all health services OOP expenditures on average among individuals older than 50 yr.