J Res Health Sci, Vol. 9, No. 2, 2009, pp.36-40 36 Catastrophic Health Expenditures in Kermanshah, West of Iran: Magnitude and Distribution *Karami M. MSc, *Najafi F. MD, PhD, **Karami Matin B. PhD *Kermanshah Health Research Center (KHRC), Kermanshah University of Medical Sciences, Iran ** Health Care Management, Kermanshah Health Research Center (KHRC), Kermanshah University of Medical Sciences, Iran (Received 19 Apr 2009; accepted 29 Aug 2009) Abstract Background: Health policy makers are concerned about protecting people from catastrophic health expenditures and subsequent impoverishment. This study aimed to describe the magnitude and distri- bution of catastrophic health expenditures in Kermanshah western Iran. Methods: In this descriptive study, during May 2008, 189 households were chosen by “Systematic Random sampling” among the community of Maskan in Maskan Center for Population. After getting the informed consent forms signed, data ere collected using a questionnaire by interviewing the head of the families. The cut-off point for catastrophic expenditure was defined as health expenditures over 40% of household’s capacity to pay. Results: From a total of 189 households, 22.2% (42) households (95% CI 16.3%- 28.1%) incurred catastrophic health expenditures. Out of 42 households, for 11.9%, the head of family was female. 40.5 % had one member younger than 12 years old, 26.2% had one member older than sixty years old, and 9.5% were households with at least one member with chronic condition. In addition, 19% were uninsured. In addition, because of financial burden of health expenditures 21.4% of the households sold their jewels, 16.7% used up their savings and 47.6% were in debt. Conclusion: Compared to 2% of general population facing catastrophic health expenditure, 22.2% was a high proportion. Our study revealed the importance of protecting households against the cost of ill-health. Keywords: Catastrophic health expenditures, Households financing contribution, Iran Introduction Health systems have three fundamental ob- jectives: improving the health of the popula- tion; meeting people’s expectations and pro- viding financial protections against the costs of ill-health (1). The fairness of health fi- nancing as a subset of the three main goals of health systems is based on the notion that every household should pay a fair share (1). Catastrophic health expenditures occur when households need to spend an important frac- tion of their net income on health care; some of them being pushed into poverty and oth- ers refuse to continue to get the care needed (1). According to World Health Organization (WHO) definition, “households with catastro- phic expenditures were defined as those with health expenditures over than 40% of house- hold's capacity to pay. The health financing contribution of a household (HFC h ) is defined as the ratio of total household spending (HS) on health and its total capacity to pay. Capacity to pay was defined as total non-food expenditure. HFC h can be summarized in the following for- mula: h h h h h Food aTax Exp HS pay to Capacity spending health Total HFC ) ( + + = = (Please note that the subscript h denotes house- hold level data) *Corresponding author: Dr Manoochehr karami, E-mail: manouchehriri@yahoo.com, Tel: +98 918 8305496 Original Article J Res Health Sci, Vol. 9, No. 2, 2009, pp.36-40