Ophthalmic Care Utilization and OutofPocket Expenditure in Iran: Kurdistan Eye Health and Economics Survey2015

Background: Due to lack of information about ophthalmic economics in Iran, health policy makers unable to distribute resources optimally in terms of efficiency and equity. Therefore, we estimated the total and eye care utilization, outofpocket expenditures, and its association with social determinants of health in Iran in 2015. #xD; Methods: A multistage populationbased, #xA0;crosssectional #xA0;study in a #xA0;random #xA0;sample aged 50 yr or older in Kurdistan Province, Northwest Iran was used. The utilization rate of eye and general health care and related outofpocket expenditures was estimated during the recent last six months. To find the association between social factors and care outofpocket expenditures, we used a Heckman twostep regression model. #xD; Results: About 81% and 37% of participants were utilized the health and ophthalmic services, respectively. Statistically significant lower ophthalmic utilization rates were observed among men, middleaged population, illiterate participants, rural residents, dailypaid workers, and the poorest participants. The average of vision and total healthrelated outofpocket expenditures among those used these services have estimated as US$43.7 (SE: 2.6) and US$439.9 (SE: 22.8), respectively. The highest (US$ 396.6) and lowest (US$ 10.4) ophthalmic outofpocket costs were related to patients with Glaucoma and Central Nervous System abnormalities, respectively. Multivariate analyses confirmed an unequal probability of having the ophthalmic outofpocket expenditures among different subgroups especially in favor of females, older, and those with more severe visual impairment. #xD; Conclusion: Ophthalmic disorders reconstituted about 10% of all health services OOP expenditures on average among individuals older than 50 yr. #xD; #xA0; #xD; #xA0;