Investigating the Factors Affecting Hospital Expenditures of Iranian Urban Households: Emphasis on Maternal Education

Introduction: Considering the high proportion of hospital expenditures in out-of-pocket payments and the importance of controlling and managing hospital expenditures to prevent catastrophic costs, the main purpose of this study was to investigate the factors affecting the hospital expenditures of Iranian urban household with emphasis on maternal education. Method: The present study is a descriptive-analytical and applied research conducted at national level using econometrics Heckman two-step model. The sample size included 15740 urban households of Iranian provinces in 2017 that was selected according to Cochran formula and three-stage sampling by the Statistical Centre of Iran. The data were also extracted from different sections of the standard questionnaire "Urban Household Cost-Income" of the Statistical Centre of Iran and processed in Stata 10 software. Results: Higher education and employment of mothers have led to a decrease in the probability of household facing hospital expenditures, by 0.002% and 0.9%, respectively. Mother’s employment, having supplementary health insurance, and bachelor's or higher education of mother resulted in a decrease in per capita hospital expenditures of households by 2058123, 1361437 and 3647518 Rials, respectively. An increase in household size, having children under the age of seven and elderly persons over sixty years old, and mothers with elementary education led to an increase in household hospital expenditures by 1347241, 4406778, 1602637 and 1674286 Rials, respectively. Conclusion: Regarding the greater impact of aging of mothers, compared to fathers, and having children and elderly persons in the household and increased hospital expenditures, protection and support of such households is necessary to achieve better health status and reduce household hospital expenditures, which can be achieved through improving and discounting insurance coverage and preventive health care. Also, investing in education to provide an appropriate condition for education of most people in the community, as well as enhancing parental health literacy through health education, is recommended.