Outpatient Healthcare Utilization, Out-of-Pocket Expenditure, and Associated Factors Among Older Adults in Fars Province, Iran: A Population-Based Cross-Sectional Study

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AuthorFatemeh Zareen
AuthorFarhad Lotfien
AuthorZahra Kavosien
AuthorZahra Goudarzien
AuthorMohsen Bayatien
OrcidFatemeh Zare [0009-0006-2577-424X]en
OrcidFarhad Lotfi [0000-0002-2323-4307]en
OrcidZahra Kavosi [0000-0001-8662-7987]en
OrcidZahra Goudarzi [0000-0002-7096-5276]en
OrcidMohsen Bayati [0000-0002-9118-5447]en
Accessioned Date2026-11-05T19:21:44Z
Issued Date2026-11-30en
AbstractBackground: Population aging is increasing demand for health care while raising concerns about direct household payments. Objectives: This study examined outpatient health care utilization, out-of-pocket (OOP) expenditure, and their associated factors among older adults in Fars Province, Iran. Methods: This population-based cross-sectional study included 700 adults aged 60 years or older selected through systematic random sampling. We collected data through structured telephone interviews using a study-specific instrument. Participants reported outpatient service use and related OOP payments during the preceding 3 months. These values were annualized by multiplying them by 4. We used negative binomial regression to examine factors associated with health care utilization and multiple linear regression to examine factors associated with OOP expenditure. Results: Participants reported a mean annual utilization of 40.00 outpatient service uses, rounded to the nearest whole service use (standard deviation [SD], 35.00), and a mean annual OOP expenditure of 344,600,400 rials (SD: 900,876,350 rials). Medication use and general practitioner consultations were the most frequently reported services, whereas specialist dental care accounted for the highest mean OOP expenditure. In the adjusted negative binomial model, incidence rate ratios (IRRs) indicated that chronic disease (IRR = 1.683; P < 0.001), high-cost medical treatment (IRR = 1.529; P = 0.001), rural residence (IRR = 1.369; P = 0.001), and access to a family physician (IRR = 1.350; P = 0.009) were associated with higher healthcare utilization. In the multiple linear regression model, high-cost medical treatment (β = 429,000,000; P = 0.002) and chronic disease (β = 204,000,000; P = 0.027) were associated with higher OOP expenditure, whereas access to a family physician was associated with lower OOP expenditure (β = −263,000,000; P = 0.038). Conclusions: Outpatient healthcare utilization and OOP expenditure were related but had partly different associated factors. Chronic disease and high-cost treatment were important factors associated with both healthcare utilization and direct payments. Access to a family physician was associated with greater healthcare utilization but lower OOP expenditure. These findings highlight the potential importance of strengthening family physician services and chronic disease management and evaluating the adequacy of coverage for high-cost outpatient care among older adults.en
DOIhttps://doi.org/10.5812/healthscope-174770en
URIhttps://brieflands.com/journals/healthscope/articles/174770en
KeywordAgeden
KeywordHealth Services Utilizationen
KeywordHealth Expendituresen
PublisherBrieflandsen
TitleOutpatient Healthcare Utilization, Out-of-Pocket Expenditure, and Associated Factors Among Older Adults in Fars Province, Iran: A Population-Based Cross-Sectional Studyen
TypeResearch Articleen

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