Introduction: Protecting households from the financial risks associated with the utilization of health care services is a cornerstone of universal health coverage. This study evaluates the extent of financial protection against health expenditures among Iranian households in 2023 using the catastrophic health expenditure (CHE) indicator.
Methods: This study utilized data from 37,710 households participating in the 2023 Household Income and Expenditure Survey. Household exposure to CHE was calculated using the budget share approach, with a threshold of 25% of household consumption expenditures, and was stratified by place of residence and income decile. The intensity of CHE was further estimated using the overshoot and mean positive overshoot measure. Descriptive statistics were employed, and all analyses were performed using Excel and Stata.
Results:  In 2023, using the budget share approach, the overall proportion of households experiencing CHE was estimated at 3.28% (95% confidence interval: 2.95–3.60), with a higher prevalence observed among rural households (4.08%) compared to urban households (3.05%). Furthermore, based on the mean positive overshoot, households incurring CHE spent, on average, 11.22% above the defined threshold, with rural households exhibiting slightly higher intensity (11.84%) than urban households (10.98%).
Conclusion: The rate of household exposure to CHE exceeds the targets set in national health policies. To enhance financial protection, efforts should focus on both reducing out-of-pocket health spending and expanding the depth of health insurance coverage, particularly for vulnerable groups.