Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
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- Journal of Preventive Medicine and Public Health
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- v.57 no.1
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- pp.65-72
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- 2024
Objectives: Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019. Methods: Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE. Results: The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05). Conclusions: Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.
Knowledge map is widely used to represent knowledge in many domains. This paper presents a method of integrating the national R&D data and assists of users to navigate the integrated data via using a knowledge map service. The knowledge map service is built by using a lightweight ontology and a topic modeling method. The national R&D data is integrated with the research project as its center, i.e., the other R&D data such as research papers, patents, and reports are connected with the research project as its outputs. The lightweight ontology is used to represent the simple relationships between the integrated data such as project-outputs relationships, document-author relationships, and document-topic relationships. Knowledge map enables us to infer further relationships such as co-author and co-topic relationships. To extract the relationships between the integrated data, a Relational Data-to-Triples transformer is implemented. Also, a topic modeling approach is introduced to extract the document-topic relationships. A triple store is used to manage and process the ontology data while preserving the network characteristics of knowledge map service. Knowledge map can be divided into two types: one is a knowledge map used in the area of knowledge management to store, manage and process the organizations' data as knowledge, the other is a knowledge map for analyzing and representing knowledge extracted from the science & technology documents. This research focuses on the latter one. In this research, a knowledge map service is introduced for integrating the national R&D data obtained from National Digital Science Library (NDSL) and National Science & Technology Information Service (NTIS), which are two major repository and service of national R&D data servicing in Korea. A lightweight ontology is used to design and build a knowledge map. Using the lightweight ontology enables us to represent and process knowledge as a simple network and it fits in with the knowledge navigation and visualization characteristics of the knowledge map. The lightweight ontology is used to represent the entities and their relationships in the knowledge maps, and an ontology repository is created to store and process the ontology. In the ontologies, researchers are implicitly connected by the national R&D data as the author relationships and the performer relationships. A knowledge map for displaying researchers' network is created, and the researchers' network is created by the co-authoring relationships of the national R&D documents and the co-participation relationships of the national R&D projects. To sum up, a knowledge map-service system based on topic modeling and ontology is introduced for processing knowledge about the national R&D data such as research projects, papers, patent, project reports, and Global Trends Briefing (GTB) data. The system has goals 1) to integrate the national R&D data obtained from NDSL and NTIS, 2) to provide a semantic & topic based information search on the integrated data, and 3) to provide a knowledge map services based on the semantic analysis and knowledge processing. The S&T information such as research papers, research reports, patents and GTB are daily updated from NDSL, and the R&D projects information including their participants and output information are updated from the NTIS. The S&T information and the national R&D information are obtained and integrated to the integrated database. Knowledge base is constructed by transforming the relational data into triples referencing R&D ontology. In addition, a topic modeling method is employed to extract the relationships between the S&T documents and topic keyword/s representing the documents. The topic modeling approach enables us to extract the relationships and topic keyword/s based on the semantics, not based on the simple keyword/s. Lastly, we show an experiment on the construction of the integrated knowledge base using the lightweight ontology and topic modeling, and the knowledge map services created based on the knowledge base are also introduced.
Recommender system has become one of the most important technologies in e-commerce in these days. The ultimate reason to shop online, for many consumers, is to reduce the efforts for information search and purchase. Recommender system is a key technology to serve these needs. Many of the past studies about recommender systems have been devoted to developing and improving recommendation algorithms and collaborative filtering (CF) is known to be the most successful one. Despite its success, however, CF has several shortcomings such as cold-start, sparsity, gray sheep problems. In order to be able to generate recommendations, ordinary CF algorithms require evaluations or preference information directly from users. For new users who do not have any evaluations or preference information, therefore, CF cannot come up with recommendations (Cold-star problem). As the numbers of products and customers increase, the scale of the data increases exponentially and most of the data cells are empty. This sparse dataset makes computation for recommendation extremely hard (Sparsity problem). Since CF is based on the assumption that there are groups of users sharing common preferences or tastes, CF becomes inaccurate if there are many users with rare and unique tastes (Gray sheep problem). This study proposes a new algorithm that utilizes Social Network Analysis (SNA) techniques to resolve the gray sheep problem. We utilize 'degree centrality' in SNA to identify users with unique preferences (gray sheep). Degree centrality in SNA refers to the number of direct links to and from a node. In a network of users who are connected through common preferences or tastes, those with unique tastes have fewer links to other users (nodes) and they are isolated from other users. Therefore, gray sheep can be identified by calculating degree centrality of each node. We divide the dataset into two, gray sheep and others, based on the degree centrality of the users. Then, different similarity measures and recommendation methods are applied to these two datasets. More detail algorithm is as follows: Step 1: Convert the initial data which is a two-mode network (user to item) into an one-mode network (user to user). Step 2: Calculate degree centrality of each node and separate those nodes having degree centrality values lower than the pre-set threshold. The threshold value is determined by simulations such that the accuracy of CF for the remaining dataset is maximized. Step 3: Ordinary CF algorithm is applied to the remaining dataset. Step 4: Since the separated dataset consist of users with unique tastes, an ordinary CF algorithm cannot generate recommendations for them. A 'popular item' method is used to generate recommendations for these users. The F measures of the two datasets are weighted by the numbers of nodes and summed to be used as the final performance metric. In order to test performance improvement by this new algorithm, an empirical study was conducted using a publically available dataset - the MovieLens data by GroupLens research team. We used 100,000 evaluations by 943 users on 1,682 movies. The proposed algorithm was compared with an ordinary CF algorithm utilizing 'Best-N-neighbors' and 'Cosine' similarity method. The empirical results show that F measure was improved about 11% on average when the proposed algorithm was used