Health Care Utilization and Expenditure in War Veterans and Their Families

Background: Medical care utilization measures are centralindicators of the performance of the health care system. Thisstudy aimed to evaluate the prevalence of health care utilizationand expenditure in war veterans and their families.Methods: This cross-sectional study was carried out on healthcare utilization (outpatient and inpatient indicators) andexpenditure in veterans and their families and costs they paid outof their own pockets. The data were collected at national levelfrom all provinces including urban as well as rural area (n=3079).Outpatient indicators included general practitioner/specialistvisits, medication and para clinical services (imaging and labtests). Required information on the latest medical services,amount of out of pocket payment and proceed to get back the costwere collected by telephone interviews. The data were analyzedin order to indicate discrepancies and determinants of healthutilization and expenses.Results: Prevalence of health care utilization in veterans and theirfamilies was 91.6% (n=2822). The study population received5127 medical services. The majority (82.5%) received one or twoservices in their last visits (about 1.82 medical services perindividual), mostly related to physician visits and medications(65.97%). The rate of hospitalization was observed in 11.7%. Therate of annual health care utilization (outpatient and inpatient) ineach war survivor or family member was totally 14.7. The annualnumber of physician visit, medication and hospitalization per yearwere 6.6, 5.1, and 0.7, respectively. About 37.4% of the studypopulation paid from their own pocket for their last medical care services. The most out of pocket payments were due tohospitalization (42.2%), imaging and laboratory test. The averagecost of payments was 27.92 US $. Gender, area of residence andnumber of medical services received were the significantdeterminants for out of pocket payments (P<0.05). More than halfof the participants who paid out of their own pockets 57%, did notproceed to get back their cost. The determinants of proceeding toreclaim the cost of medical expenditure were being familymember of veterans and higher amount of payments (P<0.05).Conclusion: Prevalence of health care utilization is high inveterans and their families. The rate of out of pocket payment ishigher for hospitalization, imaging and lab tests which highlightthe need for facilitating the rules on insurance repayment.However, whether through medical care, health is improved,unchanged, or even adversely affected should be addressed in thefuture studies.