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Volume 14, Issue 4 (2022)
Iran J War Public Health 2022, 14(4): 455-464 |
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Received: 2022/08/24 | Accepted: 2022/12/10 | Published: 2022/12/19
Received: 2022/08/24 | Accepted: 2022/12/10 | Published: 2022/12/19
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Gharibi F, Imani A, Haghi M, Dalal K. Relationship between Political-Economic Sanctions and Catastrophic Health Costs in Multiple Sclerosis Patients in Iran. Iran J War Public Health 2022; 14 (4) :455-464
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1- “Social Determinants of Health Research Center” and “Department of Community Medicine, Faculty of Medicine”, Semnan University of Medical Sciences, Semnan, Iran
2- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
3- “Social Determinants of Health Research Center” and “Department of Public Health, Faculty of Health and Nutrition”, Lorestan University of Medical Sciences, Khorramabad, Iran
4- Department of Public Health Science, School of Health Sciences, Mid Sweden University, Sundsvall, Sweden
2- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
3- “Social Determinants of Health Research Center” and “Department of Public Health, Faculty of Health and Nutrition”, Lorestan University of Medical Sciences, Khorramabad, Iran
4- Department of Public Health Science, School of Health Sciences, Mid Sweden University, Sundsvall, Sweden
Abstract (778 Views)
Aims: The political-economic sanctions imposed on different countries can have devastating effects on the country's health status, especially on patients with chronic diseases. Given the chronic and debilitating nature of multiple sclerosis, the present study aimed to investigate the relationship of Iran sanctions with the health costs of MS patients in Iran.
Instruments & Methods: This comparative study was conducted on 300 MS patients residing in the East Azerbaijan province of Iran, performed in April-May 2018 (pre-sanctions) and April-May 2019 (post-sanctions). All participants had a health record, and their treatment had started at least one year ago. The study used a validated questionnaire containing demographic/background variables, household income, costs, various imposed costs for accessing healthcare, and patients' perspectives regarding financial pressure by health costs. The rates of catastrophic health expenditures and poverty caused by the disease were calculated based on at least 40% and 50% of non-food costs spent on treatment.
Findings: The sanctions increased catastrophic health expenditures by 15% and the poverty index by 14%. In both pre-and post-sanctions phases, such background variables as occupational status, having supplemental insurance, and being native had a significant impact on the amount of out-of-pocket payments, catastrophic health expenditures, or poverty caused by disease costs (p<0.05).
Conclusion: Political-economic sanctions result in widespread negative health impacts against the sanctioned countries' citizens. They lead to increased out-of-pocket payments and decreased ability to pay for patients with multiple sclerosis and households.
Instruments & Methods: This comparative study was conducted on 300 MS patients residing in the East Azerbaijan province of Iran, performed in April-May 2018 (pre-sanctions) and April-May 2019 (post-sanctions). All participants had a health record, and their treatment had started at least one year ago. The study used a validated questionnaire containing demographic/background variables, household income, costs, various imposed costs for accessing healthcare, and patients' perspectives regarding financial pressure by health costs. The rates of catastrophic health expenditures and poverty caused by the disease were calculated based on at least 40% and 50% of non-food costs spent on treatment.
Findings: The sanctions increased catastrophic health expenditures by 15% and the poverty index by 14%. In both pre-and post-sanctions phases, such background variables as occupational status, having supplemental insurance, and being native had a significant impact on the amount of out-of-pocket payments, catastrophic health expenditures, or poverty caused by disease costs (p<0.05).
Conclusion: Political-economic sanctions result in widespread negative health impacts against the sanctioned countries' citizens. They lead to increased out-of-pocket payments and decreased ability to pay for patients with multiple sclerosis and households.
Keywords:
References
1. The World Health Organization. The world health report 2000: health systems; improving performance [Internet]. Geneva: The World Health Organization; 2000 [cited 2020 May 15]. Available from: https://apps.who.int/iris/handle/10665/79020. [Link]
2. The World Health Organization. The world health report 2010: health systems financing; the path to universal coverage [Internet]. Geneva: The World Health Organization; 2010 [cited 2020 May 15]. Available from: https://apps.who.int/iris/handle/10665/44371. [Link]
3. Azzani M, Roslani AC, Su TT. Determinants of household catastrophic health expenditure: a systematic review. Malays J Med Sci. 2019;26(1):15-43. [Link] [DOI:10.21315/mjms2019.26.1.3]
4. Russell S. The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. Am J of Trop Med and Hyg. 2004;71(2):147-55. [Link] [DOI:10.4269/ajtmh.2004.71.147]
5. Okoroh J, Essoun S, Seddoh A, Harris H, Weissman JS, Dsane-Selby L, et al. Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review. BMC Health Ser Res. 2018;18(426):1-14. [Link] [DOI:10.1186/s12913-018-3249-9]
6. Jan S, Lee SW, Sawhney JP, Ong TK, Chin CT, Kim HS. Catastrophic health expenditure on acute coronary events in Asia: a prospective study. Bull World Health Organ. 2016;94(3):193-200. [Link] [DOI:10.2471/BLT.15.158303]
7. Gharibi F, Imani A, Koustuv D. The catastrophic out-of-pocket health expenditure of multiple sclerosis patients in Iran. BMC Health Ser Res. 2021;21(1):1-8. [Link] [DOI:10.1186/s12913-021-06251-4]
8. Wagstaff A, Doorslaer EV. Catastrophe and impoverishment in paying for health care: With applications to Vietnam 1993-1998. Health Econ. 2003;12(11):921-33. [Link] [DOI:10.1002/hec.776]
9. Ariankhesal A, Etemadi M, Mohseni M, Azami-Aghdash S, Nakhaei M. Catastrophic health expenditure in Iran: a review article. Iran J Public Health. 2018;47(2):166-77. [Link]
10. Moradi G, Safari H, Piroozi B, Qanbari L, Farshadi S, Qasri H, et al. Catastrophic health expenditure among households with members with special diseases: A case study in Kurdistan. Med J Islam Repub Iran. 2017;31(43):1-7. [Link] [DOI:10.14196/mjiri.31.43]
11. Kobelt G, Lindgren P, Smala A, Joˆnsson B. Costs and quality of life in multiple sclerosis. A cross-sectional observational study in Germany. Eur J Health Econ. 2001;2:60-8. [Link] [DOI:10.1007/s101980100057]
12. Danaei G, Harirchi I, Sajadi HS, Yahyaei F, Majdzadeh R. The harsh effects of sanctions on Iranian health. Lancet. 2019;394(10197):468-9. [Link] [DOI:10.1016/S0140-6736(19)31763-5]
13. Imani A, Gharibi F, Khezri A, Joudyian N, Dalal K. Economic costs incurred by the patients with multiple sclerosis at different levels of the disease: a cross-sectional study in Northwest Iran. BMC Neurol. 2020;20(205):1-10. [Link] [DOI:10.1186/s12883-020-01790-5]
14. Hsu J, Flores G, Evans D, Mills A, Hanson K. Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring. Int J Equit Health. 2018;17(69):1-13. [Link] [DOI:10.1186/s12939-018-0749-5]
15. Meskarpour-Amiri M, Dopeykar N, Mehdizadeh P, Ayoubian A, Motaghed Z. Study on the factors affecting the prescription of injection medicines in Iran: a policy making approach. Glob J Health Sci. 2015;7(3):291-7. [Link] [DOI:10.5539/gjhs.v7n3p291]
16. Meskarpour Amiri M, Teymourzadeh E, Ravangard R, Bahadori M. Health informal payments and their main determinants: the case of Iran. Proceed Singapore Healthcare. 2019:1-10. [Link] [DOI:10.1177/2010105818822594]
17. Meskarpour-Amiri M, Assari-Arani A, Sadeghi H, Agheli L. The reality behind informal health payments in Iran: "under the table payments" or "on the table payments"? Iran J Public Health. 2017;46(2):278. [Link]
18. Xin XX, Guan XD, Shi LX. Catastrophic expenditure and impoverishment of patients affected by 7 rare diseases in China. Orphanet J Rare Dis. 2016;11(74):1-8. [Link] [DOI:10.1186/s13023-016-0454-7]
19. Habibzadeh F. Economic sanction: a weapon of mass destruction. Lancet. 2018;392(10150):816-7. [Link] [DOI:10.1016/S0140-6736(18)31944-5]
20. Arya N. Economic sanctions: the kinder, gentler alternative? Med Confl Surv. 2008;24(1):25-41. [Link] [DOI:10.1080/13623690701775205]
21. Albright MK. Economic sanctions and public health: A view from the department of state. Ann Intern Med. 2000;132(2):155-7. [Link] [DOI:10.7326/0003-4819-132-2-200001180-00012]
22. Gorji A. Sanctions against Iran: The impact on health services. Iranian J Publ Health. 2014;43(3):381-2. [Link]
23. Kokabisaghi F. Assessment of the effects of economic sanctions on Iranians' right to health by using human rights impact assessment tool: A systematic review. Int J Health Policy Manag. 2018;7(5):374-93. [Link] [DOI:10.15171/ijhpm.2017.147]
24. Shahabi S, Fazlalizadeh H, Stedman J, Chuang L, Ram R. The impact of international economic sanctions on Iranian cancer healthcare. Health Policy. 2015;119:1309-18. [Link] [DOI:10.1016/j.healthpol.2015.08.012]
25. Kobelt G, Teich V, Cavalcanti M, Canzonieri AM. Burden and cost of multiple sclerosis in Brazil. PLoS ONE. 2019;14(1):e0208837. [Link] [DOI:10.1371/journal.pone.0208837]
26. Kobelt G, Thompson A, Berg J. New insights into the burden and costs of multiple sclerosis in Europe. Mult Scler J. 2017;23(8):1123-36. [Link] [DOI:10.1177/1352458517694432]
27. Piroozi B, Moradi G, Nouri B, Mohamadi Bolbanabad A, Safari H. Catastrophic health expenditure after the implementation of health sector evolution plan: a case study in the west of Iran. Int J Health Policy Manag. 2016;5(7):417-23. [Link] [DOI:10.15171/ijhpm.2016.31]
28. Barfar E, Pourreza A, Sharifi V, Sobhanian SMH, Sari AA. Catastrophic health expenditure in households with severe mental disorders patients: Evidence after Iran's health transformation plan. Health Scope. 2019;8(2):1-6. [Link] [DOI:10.5812/jhealthscope.79700]
29. Krejcie V, Morgan DW. Determining sample size for research activities. Educ Psychol Measur. 1970;30(3):670-10. [Link] [DOI:10.1177/001316447003000308]
30. Dunn J. Impact of mobility impairment on the burden of care giving in individuals with multiple sclerosis. Expert Rev Pharmacoecon Outcomes Res. 2010;10(4):433-40. [Link] [DOI:10.1586/erp.10.34]
31. Grima DT, Torrance GW, Francis G, Rice G, Rosner AJ, Lafortune L. Cost and health related quality of life consequences of multiple sclerosis. Mult Scler. 2000;6(2):91-8. [Link] [DOI:10.1177/135245850000600207]
32. Ekman BJ. Catastrophic health payments and health insurance: Some counterintuitive evidence from one low income country. J Health Policy. 2007;83(2-3):304 - 13. [Link] [DOI:10.1016/j.healthpol.2007.02.004]
33. Daneshkohan A, Karami M, Najafi F, Karami Matin B. Household catastrophic health expenditure. Iran J Public Health. 2011;40(1):94-9. [Link]
34. Xu K, Evans DB, Kawabata K. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003;362(9378):111-7. [Link] [DOI:10.1016/S0140-6736(03)13861-5]
35. Aloosh M, Salavati A, Aloosh A. Economic sanctions threaten population health: the case of Iran. Public Health. 2019;169:10-3. [Link] [DOI:10.1016/j.puhe.2019.01.006]
36. Mohammadi S, Carlbom A, Taheripanah R, Essén B. Experiences of inequitable care among Afghan mothers surviving near-miss morbidity in Tehran, Iran: a qualitative interview study. Int J Equity Health. 2017;16(121):1-8. [Link] [DOI:10.1186/s12939-017-0617-8]
37. Choonara I. Economic sanctions and child health. Med Confl Surv. 2013;29(2):93-8. [Link] [DOI:10.1080/13623699.2012.739048]
38. Setayesh S, Mackey TK. Addressing the impact of economic sanctions on Iranian drug shortages in the joint comprehensive plan of action: promoting access to medicines and health diplomacy. Glob Health. 2016;12(31):1-14. [Link] [DOI:10.1186/s12992-016-0168-6]
39. Ghiasi G, Rashidian A, Kebriaeezadeh A, Salamzadeh J. The impact of the sanctions made against Iran on availability to asthma medicines in Tehran. Iran J Pharm Res. 2016;15(3):567-71. [Link]
40. Gharibi F, Dadgar E. Pay-for-performance challenges in family physician program. Malay Fam Physician. 2020;15(2):19-29. [Link]
41. Xu K, Evans DB, Carrin G. Protecting households from catastrophic health spending. Health Affairs. 2007;26(4):972-83. [Link] [DOI:10.1377/hlthaff.26.4.972]
42. Peyravi M, Ahmadi Marzaleh M. The effect of the US sanctions on humanitarian aids during the great flood of Iran in 2019. Prehosp Disaster Med. 2020;35(2):233-4. [Link] [DOI:10.1017/S1049023X20000242]
43. Ali MM, Shah IH. Sanctions and childhood mortality in Iraq. Lancet. 2000;355:1851-7. [Link] [DOI:10.1016/S0140-6736(00)02289-3]
44. Zakrison TL, Muntaner C. US sanctions in Venezuela: help, hindrance, or violation of human rights? Lancet. 2019;393(10191):2586-7. [Link] [DOI:10.1016/S0140-6736(19)31397-2]
45. Moret ES. Humanitarian impacts of economic sanctions on Iran and Syria. Eur Secur. 2015;24(12):120-40. [Link] [DOI:10.1080/09662839.2014.893427]
46. Devi S. Devastation in Yemen ongoing. Lancet. 2018;392(10142):110-1. [Link] [DOI:10.1016/S0140-6736(18)31607-6]
47. Lu C, Chin B, Li G, Murray CJL. Limitations of methods for measuring out-of-pocket and catastrophic private health expenditures. Bull World Health Organ. 2009;87(3):238-44. [Link] [DOI:10.2471/BLT.08.054379]