The Relationship Between the National Health Insurance Expenditures and the Burden of Disease Measures in the Iran

Abstract:

The Iranian government has considered using Disability Adjusted Life Years (DALYs) as an indicator to priorities health service expenditures to reduce the burden of disease for the public.

A cross-sectional study was designed to compare several measures of the burden of disease with the actual amounts of National Health Insurance (NHI) (the statute requiring persons to join a sickness fund and requiring employers and employee to pay premiums) expenditures, in one province of Iran (Semnan) for a period of 2 months (September 2000 & February 2001). Furthermore, on the basis of the research findings, a questionnaire was designed and distributed to stakeholders at the in local and national levels to explore their ideas about the gap between the expenditures of the diseases group and their burden. A semi-structured interview was conducted to elicit participants’ views on the research findings.

The results of this study have revealed that, currently, there is no strong relation between the NHI expenditures and DALY (r = 0.41, p = 0.09), but that there are stronger relationships between the amounts of NHI reimbursements with YLL (r = 0.52, P < 0.05), Mortality(r = 0.67, P < 0.01) and hospital days (r = 0.90, P < 0.01). Comparing each group of disorders’ DALY with the resources allocated to them (cost per DALY) it was shown that Diabetes mellitus, musculoskeletal diseases, maternal conditions, sense organ disorders received considerably generous funding; and, perinatal conditions, congenital abnormalities, nutritional deficiencies were relatively under-funded in Iran.

The qualitative research results showed that the majority of respondents agreed that the differences presently existing between disorders’ burden and NHI expenditures cannot be justified; and, further that, reducing the overall burden of disease must be one of the most important objectives for the Iranian NHI.

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