Document Type : Original Article

Authors

1 Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

2 Student Research Committee, Zahedan University of Medical Sciences, Zahedan, Iran

3 School of Public Health, Guilan University of Medical Sciences, Guilan, Iran

10.30476/jhsss.2023.97045.1691

Abstract

Background: Access to healthcare services is a prerequisite for societal justice. Unfair distribution of these services can lead to patient migration to cities with higher quality medical centers for better medical services. This study aimed to determine the direct and indirect non-medical costs of patients referred from Sistan and Balouchestan to hospitals in Mashhad.
Methods: A descriptive-analytic study was conducted in Eastern Iran in 2020. The research sample included all patients who migrated from Sistan and Balouchestan to Mashhad for medical purposes and were hospitalized in government hospitals affiliated with Mashhad University of Medical Sciences. The total number of these patients was 2062, and they were identified using a census method in 2020. Given the large population size (2060 individuals), 350 patients were selected as a sample based on the Cochrane method. A validated checklist was used for data collection, and SPSS-23 software was used for data analysis.
Results: The average direct non-medical cost for medical services in Mashhad was 61,686,857 Rials (270 USD). The highest and lowest costs were related to travel costs (26,545,714 Rials or 116 USD), and care received for children (37,142 Rials or 0.16 USD), respectively.
Conclusion: According to the results of this research, an increase in direct non-medical and indirect costs due to patient migration for treatment imposes significant costs on patients and their families. It is crucial to have an equitable distribution of health and treatment resources and facilities across a country’s geographical regions to ensure access to health services.

Highlights

Mohammad Khammarnia (Google Scholar)

Fariba Ramezani Siakhulak (Google Scholar)

Keywords

  1. Heydari, A., Delavari, S., Emadi, M., Hadipour, A., Jamali, H., & Bayati, M. (2023). Cost and expenditure of high-cost consumables in hospital: A study in a large hospital in Shiraz during 2017-2018. HMIS, 10(1), 34-39. doi: 30476/JHMI.2023.99621.1182.
  2. Newbrander W, Barnum H, Kutzin J, Organization WH. Hospital economics and financing in developing countries. World Health Organization; 1992
  3. Sturmberg JP, Bircher J. Better and fulfilling healthcare at lower costs: the need to manage health systems as complex adaptive systems. F1000Research.2019;789(8). doi: 12688/f1000research.19414.1. PMID: 31839925; PMCID: PMC6900806.
  4. Javadi M, Karimi S, Raiesi A, Yaghoubi M, Kaveh K. Comparison of patients’ and nurses’ viewpoints about responsiveness among a sample from public and private hospitals of Isfahan. IJNMR. 2011;16(4):273. doi: 10.11124/jbisrir-2015-1072. PMID: 23450853; PMCID: PMC3583095.
  5. Ramandi SD, Niakan L, Aboutorabi M, Noghabi JJ, Khammarnia M, Sadeghi A. Trend of inequality in the distribution of health care resources in Iran.JMG. 2016;5(3):122-30. doi:31661/gmj.v5i3.618.
  6. Hayati R, Setoodehzadeh F, Heydarvand S, Khammarnia M, Ravangard R, Sadeghi A, et al. The decision-making matrix of propensity to outsourcing hospital services in Bandar Abbas, Iran. JPMA . 2015;65(12):1288-94. PMID: 26627509.
  7. Ranjbar M, Bahrami MA, Baghian N, Izadi R, Eftekhari A, YousefZadeh S. The Reasons of Teaching Hospitals Selection by patients in Yazd Province for Treatment in 2016. JHM . 2017;8(1):81-90.
  8. Khammarnia M, Ghiasvand H, Javadi F, Adimi FS. Equity in the Distribution of health resources: A Case Study in Southeast Iran. Shiraz E-Medical Journal. 2021;22(8). doi: 5812/semj.106392. PMID: 34598409; PMCID: PMC7903626.
  9. Nante N, Ricchiardi G, Farraj Oa, Morgagni S, Siliquini R, Moirana F, et al. Hospital patient migration: analysis using a utility index. Public health in Europe: Springer; 2004. p. 293-316. doi: 1007/978-3-642-18826-8_27.
  10. Delil S, Çelik RN, San S, Dundar M. Clustering patient mobility patterns to assess effectiveness of health-service delivery. BMC. 2017;17(1):1-14. doi: 1186/s12913-017-2381-2. PMID: 28676090; PMCID: PMC5497378.
  11. Sabermahani A, Darijani M, Taheri A, Zeinali J. Factors Related to Patient Migration from Kerman Province to Yazd for Receiving Inpatient Services. Health and Development Journal. 2018;7(2):131-41. https://civilica.com/doc/1221381.
  12. Messina G, Vigiani N, Lispi L, Nante N. Patient migration among the Italian regions in 2003. IJPH. 2008;5(1):45-52. doi: https://doi.org/10.2427/5854.
  13. Roh C-Y, Lee K-H. Hospital choice by rural Medicare beneficiaries: does hospital ownership matter?—a Colorado case. JHHSA. 2005:346-65. doi: 1177/107937390502800304. PMID: 16583743.
  14. Bazyar M, Pourreza A, Harirchi I, Akbari F, Mahmoudi M. Medical and non-medical direct costs of cancers in patients hospitalized in Imam Khomeini cancer institution-2010. Journal Of Hospital. 2012;11(1):39-50. URL: http://jhosp.tums.ac.ir/article-1-36-en.html.
  15. Emamgholipour S, Akbari Sari A, Geravandi S, Mazrae H. Estimation of out-of-pocket and catastrophic expenditures among patients with cardiovascular diseases in Khuzestan. Payavard Salamat. 2017;11(3):297-307. URL: http://payavard.tums.ac.ir/article-1-6289-en.html.
  16. Khammarnia M, Setoodehzadeh F, Barfar E, Rezaei K, Peyvand M. Evaluation of direct medical costs in hospitalized diabetic patients after health reform plan. IRJE. 2021;16(4):363-74. URL: http://irje.tums.ac.ir/article-1-6872-en.html.
  17. Omidi M, Hosseini M, Maher A. A Survey on Patients Satisfaction from Reducing Payment in Patients Admitted to the Health Care Plan. Hakim 2018; 20(4):195-201. URL: http://hakim.tums.ac.ir/article-1-1798-en.html.
  18. Karimzadeh M, Karimzadeh B. Evaluating Development level of Sistan and Baluchistan Counties in Terms of Social Welfare Services. Regional Planning. 2019;9(34):81-94. https://dorl.net/dor/20.1001.1.22516735.1398.9.34.7.2.
  19. Khammarnia M, Setoodehzadeh F, Ansari-Moghaddam A, Barfar E, Baygi MZ, Peyvand M. Household financial contribution to the health system after Iran's Health Transformation Plan.RRH. 2020;20(1).39-48. doi: 22605/RRH5495. PMID: 32069064.
  20. Wirtz VJ, Hogerzeil HV, Gray AL, Bigdeli M, de Joncheere CP, Ewen MA, et al. Essential medicines for universal health coverage. The Lancet. 2017;389(10067):403-76. doi: 1016/S0140-6736(16)31599-9. PMID: 27832874; PMCID: PMC7159295.
  21. Su TT, Kouyaté B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bulletin WHO. 2006;84(1):21-7. DOI:2471/BLT.05.023739. PMID: 16501711; PMCID: PMC2626518.
  1. Ekman B. Catastrophic health payments and health insurance: some counterintuitive evidence from one low-income country. Health policy. 2007;83(2-3):304-13. doi: 10.1016/j.healthpol.2007.02.004. PMID: 17379351.
  2. Amaghionyeodiwe LA. Determinants of the choice of health care provider in Nigeria. Health care management science. 2008;11(3):215-27. doi: 10.1007/s10729-007-9038-3. PMID: 18826000.
  1. Ghiasvand H, Hadian M, Maleki MR, Shabaninejad H. Determinants of catastrophic medical payments in hospitals affiliated to Iran University of Medical Sciences; 2009. Hakim Journal. 2010;13(3):145-154. URL: http://hakim.tums.ac.ir/article-1-711-en.html.
  2. Barr RD, Feeny D, Furlong W. Economic evaluation of treatments for cancer in childhood.EJC. 2004;40(9):1335-45. doi: 1016/j.ejca.2004.01.033. PMID: 15177493.
  3. Park YS, Kim SH, Park SK, Park B-J, Kim YT, Lee S-M, et al. Costs for 5-year lung cancer survivors in a tertiary care hospital in South Korea. Lung cancer. 2010;68(2):299-304. doi: 1016/j.lungcan.2009.06.016. PMID: 19646776.
  4. Azzani M, Roslani AC, Su TT. Determinants of household catastrophic health expenditure: a systematicreview.MJMS.2019;26(1):15. doi: 21315/mjms2019.26.1.3. PMID: 30914891; PMCID: PMC6419871.
  5. Kavosi Z, Keshtkaran A, Hayati R, Ravangard R, Khammarnia M. Household financial contribution to the health System in Shiraz, Iran in 2012. IJHPM. 2014;3(5):243-249. doi: 15171/ijhpm.2014.87. PMID: 25337598; PMCID: PMC4204743.
  6. Semnani SH KAA. Assessing of equality on health care cost in Gorgan population laboratory study. J Gorgan Univ Sci. 2003;5(2):53-9. URL: http://goums.ac.ir/journal/article-1-183-en.html.
  7. Sepehri A, Simpson W, Sarma S. The influence of health insurance on hospital admission and length of stay—The case of Vietnam. SSRJ. 2006;63(7):1757-70. doi: 1016/j.socscimed.2006.04.029. PMID: 16766108.
  1. Larrimore J. Does a higher income have positive health effects? Using the earned income tax credit to explore the income‐health gradient. The Milbank Quarterly. 2011;89(4):694-727. doi: 10.1111/j.1468-0009.2011.00647.x. PMID: 22188352; PMCID: PMC3250638.
  2. Ernst R. Indirect costs and cost-effectiveness analysis. Value in health. 2006;9(4):253-61. doi: 10.1111/j.1524-4733.2006.00114.x. PMID: 16903995.
  3. Jones C, Parker T, Ahearn M, Mishra A, Variyam J. Health status and health care access of farm and rural populations (Economic Information Bulletin No. 57). Washington, DC: Economic Research Service, United States Department of Agriculture. 2009. doi: 10.22004/ag.econ.54430.