Masood Bagheri
1 
, Masoumeh Ebrahimi Tavani
2 , Farid Gharibi
3* 1 Clinical Research Development Center, Imam Khomeini, Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Quality Improvement, Monitoring and Evaluation Department, Center of Health Network Management, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
3 Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
Abstract
Background. Health systems are responsible for providing healthcare services for all people in a community with reasonable costs. The primary objective was to evaluate and minimize the various expenses the patients incur consistently. The current study aimed to examine the direct non-medical and indirect expenses incurred to hospitalized patients infected with the Omicron variant of COVID-19.
Methods. This cross-sectional study was conducted in February 2022 at Kosar Hospital in Semnan, Iran to investigate 400 hospitalized patients infected with the COVID-19 Omicron variant. The data were collected using a standardized instrument and conducting interviews with the patient. The descriptive findings were presented as frequencies (percentages) for qualitative variables and as means (standard deviations) for quantitative variables. The statistical relationship between demographic and background variables and the types of costs imposed on patients was examined performing t-test, ANOVA, and Tukey's post hoc test.
Results. The study findings revealed that the patients and their families spent 20,260,000 IRR on direct non-medical treatment and 28,300,000 IRR on indirect treatment. A comprehensive statistical analysis was conducted to examine the correlation between demographic and background variables and the types of the costs incurred by patients and their families. The results indicated that a previous lung disease, asthma, diabetes, an admission to the intensive care unit (ICU), a coma in the patient, and COVID-19-induced heart complications were statistically and significantly associated with the direct non-medical costs. Furthermore, it was found that variables such as age, gender, educational status, employment status, engagement in occupational and physical activities, as well as the occurrence of a coma imposed additional indirect costs on the patients and their families (P<0.05).
Conclusion. In sum, an infection with the Omicron variant of COVID-19 placed a substantial financial burden on the individuals and their households. Various factors may have influenced the magnitude of these expenses; therefore, it was recommended that these factors should be considered when implementing the promotional initiatives.
Extended Abstract
Background
A patient's inability to pay the costs associated with his/her treatment may lead to an inaccessibility to the necessary treatment or delays in receiving it and, ultimately, to compromising their health outcomes. Hence, it is imperative to ascertain the various cost categories imposed on patients and attempt to mitigate or minimize them. Although the direct medical cost incurred by hospitalized COVID-19 patients were estimated at 77,004,080 IRR, no study has examined the direct non-medical and indirect costs associated with contracting this disease. The current study aimed to examine the direct non-medical and indirect expenses incurred by hospitalized patients infected with the Omicron variant of COVID-19.
Methods
The present cross-sectional descriptive study was conducted in February 2022 at Kosar Hospital in Semnan, Iran. The study inclusion criteria were: a confirmed infection with the Omicron variant of COVID-19, hospital admission, and a minimum of one month since discharge. The sample size for the study was determined based on the total number of patient records, which consisted of 1552 individuals. A sample size of 375 individuals was identified based on the Morgan's table; however, it was subsequently increased to 400 individuals, representing a 10% increase for more accuracy. Based on the inputs from various sources, a straightforward random sampling method was employed, to collect data and to conduct interviews with the patient. The findings of the descriptive studies were presented as frequency (percentage) for the qualitative variables and as mean (standard deviation) for the quantitative variables. A range of demographic and background variables (i.e., the patient's age, gender, employment, and education status, possession of a basic and supplementary health insurance, care-seeking patterns, place of residence, presence of underlying diseases, and type and severity of COVID-19 complications) was examined. The relationships between these variables and the financial burden experienced by the patient and their family were also explored by performing various statistical tests (i.e., the t-test, ANOVA, and Tukey's post hoc test) based on the characteristics of the independent and dependent variables.
Results
Our study results revealed that the patients and their families spent 20,260,000 IRR on direct non-medical treatment, with the highest costs paid for food preparation during the care seeking, transportation expenses to and from the care centers, and the costs associated with medical and care equipment. Approximately 4% of the individuals afflicted by the COVID-19 pandemic lost their jobs. Furthermore, 32% of the patients received a reduced income due to their work absence caused by COVID-19, and 34% of households had a reduced income due to the absence of their family members in need of care provision.
The results, moreover, showed that the total amount of indirect costs was 28,300,000 IRR. These costs encompassed the financial impact resulting from the patient's absence from work, the reduction in income of the family members due to their absence from work, and the expenses associated with the patient's job loss. According to the results from a careful analysis of the statistical correlation between significant demographic/ contextual factors and the extent of direct non-medical expenses incurred, those individuals afflicted with lung disease, asthma, and diabetes were more susceptible to the higher costs than those without the given medical conditions. Furthermore, the patients admitted to ICU, experienced coma, or developed heart complications due to COVID-19 were subjected to the increased direct non-medical costs. Examination of the statistical correlation between the demographic/background variables and the level of indirect costs also demonstrated that the patients with younger age, male gender and no university degrees, the patients employed as workers or freelancers, as well as the individuals with a state of coma paid higher indirect costs compared to other groups.
Conclusion
It was concluded that the COVID-19 disease, as anticipated, incurred substantial direct non-medical and indirect costs on the patients and their families. Several factors, including prior infection with an underlying disease, exposure to COVID-19 side effects, and employment status, influenced the extent of these costs. Our study findings may have proved valuable to the health system managers/policymakers and helped them to formulate and execute effective promotional interventions.