Table 1.
The data extraction and quality of the studies (population level)
| Study quality | CHE (%) | Data collection method | Sample size | Population | Years of study | Publication type—language | Study design | Author (year) | N |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Nekoei-Moghadam et al. (2012) | Descriptive–analytical study | Article—English | 2008 | Iranian households | 39,008 | Secondary data | 2.8% | Good |
| Determinants of exposure to CHE: use of outpatient service, drug addiction cessation services, Inpatient service—household size (3 ≤ x < 6) (+)—economic status—pharmaceutical expenses—health insurance | |||||||||
| 2 | Ghiasvand et al. (2015) | Descriptive study | Article—English | 2013–2014 | Iranian households |
Total: 38,318 19,437 (rural) 18,888(urban) |
Secondary data | Rural: 11.7% Urban: 11.45% | Good |
| Determinants of exposure to CHE | |||||||||
| 3 | Karami et al. (2009) | Descriptive study | Article—English | 2008 | Kermanshah | 189 | questionnaire | 22.2% | Medium |
| Determinants of exposure to CHE | |||||||||
| 4 | Daneshkohan et al. (2011) | Descriptive study | Article—English | 2008 | Kermanshah | 189 | Questionnaire | 22.2% | Good |
| Determinants of exposure to CHE | |||||||||
| 5 | Ghoddoosinejad et al. (2014) | Cross-sectional descriptive study | Article—English | 2013 | Ferdows | 100 | Questionnaire | 24% | Medium |
| Determinants of exposure to CHE: use of dentistry services | |||||||||
| 6 | Kavosi et al. (2012) | Longitudinal study | Article—English | 2003 and 2008 | South-west Tehran |
579 (2003) 592 (2008) |
Questionnaire | 12.6% (2003), 11.8% (2008) | Good |
| Determinants of exposure to CHE: economic status—member over 65 years (+)—disabled members—health insurance- use of dentistry services, outpatient service, inpatient service | |||||||||
| 7 | Saber-Mahani et al. (2014) | Cross-sectional study | Article—Persian | 2011 | Tehran | 34,700 | Secondary data | 11.3% | Medium |
| Determinants of exposure to CHE: number of members under 5 years (+)—number of members over 65 years (+)—employed head—education status of household head (−)—chronic disease members—health insurance—age of household head (+)—equivalent household size (−)—income deciles (+)—per capita household expenditure (−)—number of the employed persons in household | |||||||||
| 8 | Amery et al. (2013) | Cross-sectional study | Article—Persian | 2011 | Yazd | 386 | Questionnaire | 8.3% | Medium |
| Determinants of exposure to CHE: use of inpatient services—household size (> 7) (+)—members under 5 years (−)—use of medical services and diagnosis | |||||||||
| 9 | Soofi et al. (2013) | Cross-sectional study | Article—Persian | 2001 | Iranian households | 10,300 | Secondary data | 15.31% | Medium |
| Determinants of exposure to CHE: living in the urban (−)—household size (+)—member with chronic illness—member in need of care—economic status—health insurance—use of outpatient service | |||||||||
| 10 | Kavosi et al. (2009) | Longitudinal study | Article—Persian | 2003–2008 | Tehran | 579 (2003), 592 (2008) | Questionnaire | 12.6% (2003), 11.8% (2008) | Medium |
| Determinants of exposure to CHE: use of inpatient service, dentistry services—member over 65 years (+)—member in need of care—number of use of outpatient services—economic status | |||||||||
| 11 | Amery et al. (2012) | Cross-sectional study | Article—Persian | 2012 | Mashhad | 384 | Questionnaire | 6.77% | Medium |
| Determinants of exposure to CHE: household size (> 7) (+)—health insurance—use of inpatient service, dentistry services, medicinal and diagnostic services—member over 65 years (+)—pharmaceutical expenses—members under 5 years (−) | |||||||||
| 12 | Rezapour et al. (2013) | Cross-sectional study | Article—English | 2013 | Tehran | 2200 | Interviews, and Questionnaire | 6.45% | Good |
| Determinants of exposure to CHE: number of use of outpatient services—education status of household head (+)—household size (+)—preschool children living in household (−)—member with chronic illness | |||||||||
| 13 | Aeenparast et al. (2016) | Review literature on studies | Article—Persian | Not reported | Iranian households | 19 papers | – | 2.5% to 72.5% | Weak |
| Determinants of exposure to CHE | |||||||||
| 14 | Asefzadeh et al. (2013) | Cross-sectional–descriptive–analytical study | Article—Persian | 2011 | Qazvin | 100 | Questionnaire | 24% | Medium |
| Determinants of exposure to CHE: use of dentistry servicesDeterminants of exposure to CHE: use of dentistry services | |||||||||
| 15 | Raghfar et al. (2013) | Longitudinal study | Article—Persian | 1984 to 2010 | Iranian households | 30,000 households in each year | Secondary data |
6.78% to 5.76% (rural) 3.9% to 5.76% (urban) |
Weak |
| Determinants of exposure to CHE | |||||||||
| 16 | Fazaeli et al. (2015) | Cross-sectional–descriptive–analytical study | Article—English | 2010 | Iranian households | 28,997 | Secondary data | 2.1% | Medium |
| Determinants of exposure to CHE: living in the urban (−)—number of members over 65 years (+)—education status of household head (+)—employment situation of household head—number of the employed persons in household—expenditure deciles (+)—equivalent household size (+) | |||||||||
| 17 | Masaeli et al. (2015) | Descriptive–analytical study | Article—Persian | 2011 | Iranian households | 38,437 | Secondary data | 1.56% | Medium |
| Determinants of exposure to CHE | |||||||||
| 18 | Mehrara et al. (2010) | Longitudinal study–descriptive–analytical study | Article—Persian | 2003–2007 | Iranian households |
31,283 (2007) 2003–2004-2005-2006 (not reported) |
Secondary data |
2.3% (2003) 1.9% (2004) 2.4% (2005) 2.3% (2006) 2.5% (2007) |
weak |
| Determinants of exposure to CHE: living in the urban (−)—number of members over 60 years (+)—number of members under 12 years (+)—health insurance—employment situation of household head—number of members employed in the household (+)—marital status (single head) (+)—per capita infrastructure residential area of the household, wealth index (−)—equivalent household size (+)—expenditure deciles (+)—equivalent per capita household expenditure (+) | |||||||||
| 19 | Fazaeli (2007) | Longitudinal study | Thesis—Persian | 2003–2006 | Iranian households |
23,134 (2003) 24,534 (2004) 26,895 (2005) 30,910 (2006) |
Secondary data |
2.28% (2003) 1.9% (2004) 2.36% (2005) 2.26% (2006) |
Medium |
| Determinants of exposure to CHE: age of household head (−)—number of members employed in the household (−)—health insurance—members over 60 years (+)—living in the urban (−)—education status of household head (−)—employment situation of household head—per capita household expenditure— (+)per capita infrastructure residential area of the household, wealth index (−) | |||||||||
| 20 | Kavosi et al. (2014) | Cross-sectional study | Article—English | 2012 | Shiraz | 761 | Questionnaire | 14.2% | Good |
| Determinants of exposure to CHE: Economic status (−)—use of dentistry services, inpatient services, physician visits—frequency of use of outpatient services—health insurance—supplementary insurance status of household head—member in chronic need of medical care- living in the urban (−) | |||||||||
| 21 | Nekoei-moghadam et al. (2014) | Descriptive–analytical retrospective | Article—Persian | 2008 | Kerman | 1477 | Secondary data | 4.1% | Good |
| Determinants of exposure to CHE: living in the urban (+)—use of inpatient services, outpatient services, dental care services | |||||||||
| 22 | Fazaeli et al. (2015) | Longitudinal study | Article—English | 2003 to 2010 | Iranian households | 23,134 to 38,170 for each year | Secondary data |
2.28% (2003) 1.91% (2004) 2.37% (2005) 2.27% (2006) 2.49% (2007) 2.46% (2008) 2.82% (2009) 3.06% (2010) |
Medium |
| Determinants of exposure to CHE | |||||||||
| 23 | Yousefi et al. (2015) | Cross sectional–descriptive study | Article—Persian | 2011 | Iranian households | 36,071 | Secondary data | 3.38% | Medium |
| Determinants of exposure to CHE | |||||||||
| 24 | BagheriFaradonbeh et al. (2016) | Cross-sectional study | Article—Persian | 2013 | Tehran | 625 | Interview and observation using a Questionnaire | 3.8% | Medium |
| Determinants of exposure to CHE: use of inpatient services- education status of household head (−)—number of use of health services—informal payment (+)—member over 65 years (+) | |||||||||
| 25 | Piroozi et al. (2016) | Cross-sectional, descriptive–analytical study | Article—English | 2015 | Sanandaj | 646 | Face-to-Face Interviews—Questionnaire | 4.8% | Good |
| Determinants of exposure to CHE: supplementary health insurance—gender of the head of household (female)(+)—economic status—members over 65 years(+)—disabled member and in need of care—use of inpatient services, dental care services, rehabilitation services | |||||||||
| 26 | Hanjani et al. (2006) | Cross-sectional study | Article—Persian | 2002 | Iranian households | 32,152 | Secondary data | 3.94% | weak |
| Determinants of exposure to CHE: age of household head (+)- living in the urban (−)—health insurance—education status of household head (−)—employment situation of household head—marital status (married) (+)—gender of the head of household (male) (+)—household size (−) | |||||||||
| 27 | Ghiasi (2016) | Cross-sectional, descriptive–analytical study | Article—Persian | 2013–2014 | Zabol | 393 | Questionnaire | 20.6% | Good |
| Determinants of exposure to CHE: education status of household head (−)—pharmaceutical expenses | |||||||||
| 28 | Rezapour et al. (2016) | Cross-sectional study | Article—Persian | 2013 | Tehran | 625 | Questionnaire | – | Medium |
| Determinants of exposure to CHE: education status of household head (−)—health insurance—members over 60 years (+)—inpatient service—informal payment (+)—number of use of health services | |||||||||
| 29 | Fattahi et al. (2015) | Cross-sectional study–case study | Article—Persian | 2012–2013 | Hossein Abad district of Uremia | 300 | Questionnaire | – | Medium |
| Determinants of exposure to CHE: wealth index(−)—gender of household head (male) (−)—household size (+)—members under 12 years (+)—employment situation of household head—number of use of inpatient services—health insurance—supplemental insurance | |||||||||
| 30 | Nouraei-Motlagh S (2017) | Descriptive-analytical–retrospective study | Article—Persian | 2012 | Deprived states of Iran | 22,057 | Secondary data | 6.25% | Medium |
| Determinants of exposure to CHE: expenditure deciles (+)—use of dentistry services, inpatient service—member over 65 years (+)—employment situation of household head—education status of household head (−)—health insurance—equivalent household size (−)—gender of the head of household (female) (+)—living in the urban (−) | |||||||||
| 31 | Abolhallaje et al. (2013) | Analytical study | Article—English | 2002–2005–2008 | Iran | – | Secondary data | – | Medium |
| Determinants of exposure to CHE: employment situation of the head of household—education of the head—gender of the head of household—age of the head—number of the members of household—number of the members over 60—number of kids below 12—number of the employed persons in household—health insurance—large/small housing | |||||||||
| 32 | Davari et al. (2015) | Retrospective cross sectional study | Article—English | 2004 and 2011 | Chaharmahal and Bakhtiary |
715 (2004) 1001(2011) |
Secondary data |
2004 3.4% (rural) 1.7% (urban) 2011 0% (rural) 1.7% (urban) |
Medium |
| Determinants of exposure to CHE | |||||||||
| 33 | Homaie-Rad et al. (2017) | Before-and-after analysis | Article - English | 2013 [before the reform] and 2015 [after the reform] | Guilan |
1217 (2013) 1205 (2015) |
Secondary data |
5.75% (2013) 3.82% (2015) |
Good |
| Determinants of exposure to CHE | |||||||||
| 34 | Homaie-Rad et al. (2016) | Cross -sectional study | Article—English | 2012 | Iran retirees | 6307 | Secondary data | 0.6% | Medium |
| Determinants of exposure to CHE | |||||||||
| 35 | Khadivi et al. (2016) | Descriptive-analytical study | Article—Persian | 2013 | Construction workers in Isfahan | 400 | Questionnaire | 4.75% | Medium |
| Determinants of exposure to CHE | |||||||||
| 36 | Yazdi-Feyzabadi et al. (2017) | Retrospective study | Article—Persian | 2008–2014 | Iranian provinces | Not reported | Secondary data | 2.7% | weak |
| Determinants of exposure to CHE | |||||||||
| 37 | Ghafoori et al. (2014) | Descriptive–analytic study | Article—English | 2012 | 22 districts of Tehran | 784 | Questionnaire | 7.2% | Medium |
| Determinants of exposure to CHE | |||||||||
| 38 | Ahmadnezhad et al. (2019) | Cross-sectional survey | Article—English | 2013–2016 | Iranian households | Not report | Secondary data | 3.76% (2013) 3.82% (2016) | Good |
| Determinants of exposure to CHE: health transformation plan | |||||||||
| 39 | Yazdi-Feyzabadi et al. (2019) | Cross-sectional survey | Article—English | 2011–2017 | Iranian households |
Total: 76,300 38,434 (2011) 37,866 (2017) |
Secondary data | 1.99% (2011) 3.46% (2017) | Good |
| Determinants of exposure to CHE: health transformation plan had no considerable success in financial protection, requiring a review in actions to support pro-poor adaptation strategies | |||||||||
| 40 | Yazdi-Feyzabadi et al. (2018) | Descriptive study | Article—English | 2008–2015 | Iranian households |
Total: 77,156 39,008 (2008) 38,148 (2015) |
Questionnaire | 2.57% (2008) 3.25% (2015) | Good |
| Determinants of exposure to CHE: health insurance | |||||||||