Volume 8, Issue 1 (Spring 2025)
Iran J Health Insur 2025, 8(1): 81-89 |
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Research code: IR.TUMS.SPH.REC.1400,290
Ethics code: IR.TUMS.SPH.REC.1400,290
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Razimoghadam M, Yaseri M, Meshkani Z, Daroudi R. Patterns of Health Care Expenditure by Age, Gender, and Disease: A Cross-Sectional Study Based on Iran Health Insurance Data. Iran J Health Insur 2025; 8 (1) :81-89
URL: http://journal.ihio.gov.ir/article-1-356-en.html
URL: http://journal.ihio.gov.ir/article-1-356-en.html
1- National Center for Health Insurance Research, Tehran, Iran & Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3- National Center for Health Insurance Research, Tehran, Iran
4- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ,rdaroudi@sina.tums.ac.ir
2- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3- National Center for Health Insurance Research, Tehran, Iran
4- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ,
Abstract: (1369 Views)
Introduction: Estimating healthcare expenditures based on the characteristics of service recipients provides insight into resource allocation and identifies beneficiaries of healthcare spending.
Methods: This cross-sectional quantitative study analyzed inpatient records of individuals covered by the Iranian Health Insurance Organization in 2020 and 2021. Hospital costs were examined from the perspective of the Iranian Health Insurance Organization. The study included qualitative variables such as patient age and gender, disease groups classified according to the ICD-10th, hospital type, case type, and insurance fund.
Results: A total of 7.6 million inpatient records were reviewed. The median hospital expenditure of the Iranian Health Insurance Organization was 13,989,649 Iranian Rials. The highest costs were associated with the 15–44 age group. A large part of the costs were related to women of reproductive age and to receiving services related to pregnancy, childbirth, and the puerperium. The elderly population (64 years and older) incurred the next highest costs. The patient groups incurring the highest costs were those diagnosed with COVID-19 and circulatory system diseases. Additionally, mental and behavioral disorders, congenital malformations, deformations and chromosomal abnormalities, and musculoskeletal system diseases had the highest costs per hospital visit.
Conclusion: Cost analysis is a tool for predicting future costs and sustainable financing. Given the country's demographic trends, particularly the aging population, preventive interventions and the promotion of a healthy lifestyle are recommended. Furthermore, preventing diseases of the circulatory system and mental and behavioral disorders should be prioritized in health policies.
Methods: This cross-sectional quantitative study analyzed inpatient records of individuals covered by the Iranian Health Insurance Organization in 2020 and 2021. Hospital costs were examined from the perspective of the Iranian Health Insurance Organization. The study included qualitative variables such as patient age and gender, disease groups classified according to the ICD-10th, hospital type, case type, and insurance fund.
Results: A total of 7.6 million inpatient records were reviewed. The median hospital expenditure of the Iranian Health Insurance Organization was 13,989,649 Iranian Rials. The highest costs were associated with the 15–44 age group. A large part of the costs were related to women of reproductive age and to receiving services related to pregnancy, childbirth, and the puerperium. The elderly population (64 years and older) incurred the next highest costs. The patient groups incurring the highest costs were those diagnosed with COVID-19 and circulatory system diseases. Additionally, mental and behavioral disorders, congenital malformations, deformations and chromosomal abnormalities, and musculoskeletal system diseases had the highest costs per hospital visit.
Conclusion: Cost analysis is a tool for predicting future costs and sustainable financing. Given the country's demographic trends, particularly the aging population, preventive interventions and the promotion of a healthy lifestyle are recommended. Furthermore, preventing diseases of the circulatory system and mental and behavioral disorders should be prioritized in health policies.
Keywords: Hospital Costs, Health Insurance, Health Expenditures, Age Distribution, Gender Distribution, Disease-Specific
Type of Study: Short Communication |
Subject:
Special
Received: 2025/03/8 | Revised: 2025/10/8 | Accepted: 2025/05/31 | ePublished: 2025/07/28
Received: 2025/03/8 | Revised: 2025/10/8 | Accepted: 2025/05/31 | ePublished: 2025/07/28
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