Decomposed Trends of Iranian Private Health Expenditures: Should Inequality be Appreciated?

Background: Inequalities in health and health care have drawn considerable attention in social determinants of health literature. This study aims to calculate the inequality of out-of-pocket health payments (OPHP) for Iranian households during the period 1984 to 2019 and provide decomposed inequality for households with different socioeconomic status. Methods: This longitudinal study utilized the Iranian Statistics Centre data on Iranian household income and expenditures survey. The analysis includes a total of 995,300 households during a 36-year period from 1984 to 2019. The Theil index and the mean logarithmic deviation were used to decompose inequality into within-group and between-group for OPHP among Iranian households. Results: The findings indicate that the mean of the Theil index for the households covered by insurance is 1.44 (SD ± 0.34), while the index was 1.35 (SD ± 0.31) for households without insurance coverage. The mean of the Theil index for rural and urban households was 1.29 (SD ± 0.29) and 1.43 (SD ± 0.33), respectively. Regardless of the fluctuations, the trends of between- group and within group inequalities in OPHP were almost similar until 2011, but they followed a different path since then. Conclusion: Households living in cities, households with insurance coverage, and households in high income levels have experienced more inequality in OPHP than other households. This study provides a novel interpretation of inequality in health care expenditures and provides a long-term time series data to assess the effectiveness of implemented policies in health care system.

Cost analysis of breast cancer: a comparison between private and public hospitals in Iran.

BACKGROUNDS: Breast cancer is the most prevalent cancer among women. Breast cancer imposes a considerable economic burden on the health system. This study aimed to compare the cost of breast cancer among patients who referred to private and public hospitals in Iran (2017). METHODS: This was a prevalence-based cost of illness study. A total of 179 patients were selected from private and public hospitals using the census method. The researcher-constructed checklist was used for data collection. Data were analyzed using SPSS software version 22. RESULTS: The estimated total mean (SD) direct cost of patients who referred to the private hospital and the public hospital was $10,050 (19,480) and $3960 (6780), respectively. Further, the total mean indirect cost of patients who referred to the private hospital was lower than those referring to the public hospital at $1870 (15 % of total costs) and $22,350 (85 % of total costs), respectively. These differences were statistically significant (P < 0.05). CONCLUSIONS: Breast cancer imposes a substantial cost on patients, health insurance organizations and the whole society in Iran. Therefore, the adoption of effective measures for the prevention and early diagnosis of breast cancer is urgently needed.

Determinants and causes of maternal mortality in Iran based on ICD-MM: a systematic review.

BACKGROUND: No systematic review has explored the causes of and factors associated with maternal mortality in the context of Iran. This study reviewed determinants and causes of maternal mortalities during pregnancy, delivery and the puerperium using the International Classification of Diseases-Maternal Mortality (ICD-MM), introduced by the World Health Organization. METHODS: A systematic electronic search of all the studies that identified causes and/or determinants of maternal deaths in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies to include in this study, a combination of hand searching and bibliographies was also conducted. These sources and citations yielded a total of 653 articles; nevertheless, only 29 articles met the inclusion criteria, hence, required data were extracted, summarized, and grouped together from these papers and are reported in the tables. RESULTS: Amongst the 29 studies published between 2003 and 2017 in Iran, 24 studies were cross-sectional. Overall, 4633 deaths were reviewed, and 2655 (58%) of the cases included the data on the causes of death generally. According to the ICD-MM, a total of 69.9, 20.6, and 5.2% of the mortalities were due to direct, indirect and unspecified causes respectively and 4.3% of the causes were not clear in several studies. The leading direct and indirect causes of death were identified as hemorrhage (30.7%) and hypertensive disorders (17.1%) and circulatory system diseases (8.1%) respectively. Several factors including gravidity, type of delivery, socio-economic status of mothers, locations of birth, death and maternity care venues were found in the original studies as the most important determinant of maternal mortalities in Iran. CONCLUSIONS: This study, provided an updated summary of evidences on the causes and determinants of maternal death in Iran, which is critically important for the development of interventions and reduction of the burden of maternal mortality and morbidities.

Ageing and inpatient hospital expenditures: A study of steepening.

Background: Considering the health economics aspect, the effect of population aging on the growth of medical expenditures is of great importance. Thus, the aim of this study was to investigate the growth rate of inpatient hospital expenditures (IHE) of older age groups compared to younger age groups or testing of steepening hypothesis. Methods: In this descriptive-analytic study, monthly IHE data of insured patients from April 2011 to March 2014 was collected from Iran Health Insurance Organization database. The sample consisted of 297,145 patients who were selected using stratified random sampling among the patients insured by different health insurance funds. Using the Age-cut method, patients were classified into two main age groups: older than 60 and under 60 years old. The average IHE of the two groups and the growth rate of their expenditures were estimated. At the 95% significance level, the difference in average growth rate of IHE was tested between the two age groups using tstatistic in Stata (version 13.0) software. Results: The findings of this study revealed that per capita IHE for the older and younger groups was $469 and $399, respectively. The monthly average growth rate of IHE for the older (60-90 yrs.) and younger groups (30-59 yrs.) was 2.43% and 2.38%, respectively. The difference between the monthly average growth rate of the older and younger groups was not statistically significant (t = - 0.0332; P value = 0.9736). Conclusion: Our study results rejected the steepening hypothesis. The monthly average growth rates of IHE in both older and younger age groups have risen to a similar extent over the period of 36 months. Further research should focus on the inpatient hospital expenditures of younger age groups to explain the causes of their increased expenditures.

Individual consequences of having work and family roles simultaneously in Iranian married women.

Because of the paucity of studies about the consequences of women's work and family responsibilities in Iran, in the present study the authors used a qualitative approach to begin to provide in-depth answers to the following question: What are the consequences of having work and family responsibilities in Iranian married women? Data were obtained from 29 participants using individual in-depth interviews conducted with 17 participants in addition to two focus groups (n = 6 per group), all conducted in the second half of 2014. All of the participants were Iranian nationals, married, and held a full-time job outside the home. Five main themes were derived from the study: "promotion of self-esteem and social status," "facing difficulties," "effort and dedication," "unfulfilled needs and non-optimal health," and "restless mind." Participants reported achieving a number of advantages for themselves and their families as a result of working outside the home; but, they also had many problems with the potential to impair various health aspects, including physical, reproductive, and mental health. Thus, it is important for Iranian health-care providers to consider the effect of the work-family interference on women.

Health production and determinants of health systems performance in WHO Eastern Mediterranean Region.

This descriptive-analytical study used data envelopment analysis to evaluated the technical efficiency (TE) of health systems in Member States of the World Health Organization Eastern Mediterranean Region during 2004-2011. Life expectancy and infant mortality were used as outputs. Per capita total expenditure on health, and number of physicians, nurses and midwives and hospital beds per 1000 people were used as inputs. The determinants of TE of the health systems were examined using a regression model. United Arab Emirates and Somalia had the most efficient health systems with a TE score of 1. Djibouti and Libya had the most inefficient health systems, with TE scores of 0.346 and 0.435, respectively. The most important determinants of TE were the level of education and gross domestic product per capita. The relationship between unemployment and out-of-pocket health expenditure was not significantly associated with TE of the health systems. To improve TE of the health systems, countries should focus on individuals' empowerment in education and income level, rather than only on providing healthcare services.

Factors affecting the informal payments in public and teaching hospitals.

BACKGROUND: Informal payments in the health sector of many developing countries are considered as a major impediment to health care reforms. Informal payments are a form of systemic fraud and have adverse effects on the performance of the health system. In this study, the frequency and extent of informal payments as well as the determinants of these payments were investigated in general hospitals affiliated to Tehran University of Medical Sciences. METHODS: In this cross-sectional study, 300 discharged patients were selected using multi-stage random sampling method. First, three hospitals were selected randomly; then, through a simple random sampling, we recruited 300 discharged patients from internal, surgery, emergency, ICU & CCU wards. All data were collected by structured telephone interviews and questionnaire. We analyzed data using Chi- square, Kruskal-Wallis and Mann-Whitney tests. RESULTS: The results indicated that 21% (n=63) of individuals paid informally to the staff. About 4% (n=12) of the participants were faced with informal payment requests from hospital staff. There was a significant relationship between frequency of informal payments with marital status of participants and type of hospitals. According to our findings, none of the respondents had informal payments to physicians. The most frequent informal payments were in cash and were made to the hospitals' housekeeping staff to ensure more and better services. There was no significant relationship between the informal payments with socio-demographic characteristics, residential area and insurance status. CONCLUSION: Our findings revealed that many strategies can be used for both controlling and reducing informal payments. These include training patients and hospitals' staff, increasing income levels of employees, improving the quantity and quality of health services and changing the entrenched beliefs that necessitate informal payments.

Erratum to: Rhinoplasty as a Medicalized Phenomenon: A 25-Center Survey on Quality of Life Before and After Cosmetic Rhinoplasty.

Erratum to: Aesth Plast Surg (2014) 38:615­619. DOI 10.1007/s00266-014-0323-5. The correct affiliation for A. Pourreza, M. Mahmoodi, and F. Akbari is Tehran University of Medical Sciences. The authors regret their error.

Rhinoplasty as a medicalized phenomenon: a 25-center survey on quality of life before and after cosmetic rhinoplasty.

BACKGROUND: Cosmetic surgery, including rhinoplasty, has been dramatically increasing in Iran through the last two decades. It is performed mainly on the youth for the purpose of beauty, an area not directly related to medicine but strongly medicalized. This study aimed to explore the effects of rhinoplasty on the quality of life experienced by individuals who have undergone the surgery. METHODS: From all the plastic surgery clinics in Teheran, 25 were selected randomly as sites for the study. In the next step, 110 patients who had undergone rhinoplasty were selected randomly from these clinics. Only patients whose surgery had been performed 3 to 18 months before the interview were included in the statistical population. Data were collected through a Likert-type questionnaire that queries three major quality-of-life dimensions: general benefit, social support, and physical health. The collected data were analyzed by SPSS. RESULTS: The mean scores for quality of life before and after surgery were 66.54 and 61.11, respectively. The difference was statistically significant (P = 0.008), showing a decline in quality of life after rhinoplasty. Whereas the mean score for social support and physical health decreased, the score for general benefit increased after the surgery. The main motivating factors for surgery were external factors (e.g., friends, family). In addition, the date of the surgery and the time of the interview were positively correlated. In other words, the longer the time since surgery, the greater was the increase in the patients' satisfaction and quality of life. CONCLUSIONS: The overall quality of life among the statistical population decreased. This could be attributed to unnecessary surgeries, medical errors, and performance of rhinoplasty because of its recognized popularity. The reduction in social support may have resulted from unacceptable consequences of rhinoplasty, particularly in terms of appearance, and reactions of family and peer group. The physical health of the respondents was negatively affected by rhinoplasty. Malfunction of the upper respiratory system after rhinoplasty is a known main reason for the negative effect of rhinoplasty on the quality of life. Correlations between the times of the surgery and the interview suggest a long-term rather than an immediate assessment of effects that such surgeries have on the quality of life. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Developing a Persian inpatient satisfaction questionnaire.

PURPOSE: Valid and reliable measures are required for assessing patient satisfaction meaningfully. The purpose of this paper was to develop and validate a Persian-language in-patient satisfaction questionnaire for patients discharged from Iranian medical and surgical services. DESIGN/METHODOLOGY/APPROACH: The cross-sectional survey included 400 patients randomly selected from six Tehran hospitals. A total of 405 patients responded to the questionnaire (76.3 percent response). To assess inter-item reliability and construct validity, factor analysis was carried out. Items belonging to each factor and their Cronbach's alpha coefficient were calculated. FINDINGS: A total of seven dimensions were identified: doctor-patient communication; nursing care; convenience; visitors; cleanliness; costs; and general satisfaction. Together, these dimensions explained 60 percent of the variance. All items, except three, revealed loadings above 0.4, while Cronbach's alpha exceeded 0.8 for all dimensions, except visitors (0.66). Patient satisfaction levels were relatively high. PRACTICAL IMPLICATIONS: Results must be interpreted cautiously owing to high satisfaction, which should not be considered as comprehensive evidence of high performance without important additional service-performance information. Qualitative studies are recommended to complement the authors' quantitative satisfaction study. ORIGINALITY/VALUE: The patient satisfaction questionnaire strives to be a valid and reliable instrument for assessing in-patient satisfaction with hospital services in Iran.

Development and psychometric evaluation of the questionnaire on the contributing factors of tendency towards voluntary single-childedness and childlessness: a mixed method study.

Couples' tendency towards voluntary single-childedness and childlessness (VSCC) has turned into a major challenge in all societies and led to different problems such as population aging. A key step to VSCC management is to determine its contributing factors through valid and reliable instruments. This exploratory sequential mixed method study (qualitative-quantitative) was conducted in 2020-2021. Phases of qualitative consists of all couples aged 15-49 in Babol, Iran, who were single or childless. Sampling is based on the purpose, and the number of samples is 20 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Sampling continued until data saturation. The data were analyzed by the conventional content analysis method and quantitative phase. Initially, a qualitative study was conducted on twenty couples, and were analyzed through conventional content analysis. Findings were used to develop QFT-VSCC and then, the face, content, and construct validity as well as reliability were assessed. Construct validity was assessed through exploratory and confirmatory factor analyses and reliability was assessed through internal consistency and stability assessments. The results of the qualitative part analysis consist of 140 codes, 30 primary categories, and nine main categories and two themes (individual limitations and social limitations). The primary QFT-VSCC had 78 items. Fifty-eight items were omitted during validity assessment and the remaining twenty-two items were loaded on five factors during factor analysis. These factors were threatened priorities, inappropriate familial context for childbearing, sense of occupational and social insecurity for the child, social modeling of childlessness, and tendency towards change or stability in marital life. The five factors explained 52.56% of the total variance. All model fit indices in confirmatory factor analysis were acceptable and the Cronbach's alpha values of QFT-VSCC and all its factors were more than 0.70. The results of convergent validity analysis revealed that all factors had an AVE value greater than 0.5, and the HTMT index for all factors was less than 0.85. This indicated that discriminant validity had been achieved. QFT-VSCC is a simple valid and reliable instrument for VSCC assessment among both men and women.

Effective factors on voluntary childlessness and one-child tendency from couples' perspective: Compulsory childlessness or child-avoidance?

Background: Couples' childless and one-child intention is one of the crucial challenges in all societies. Considering the aging of the world's population and the need to review birth control policies, it is necessary to take evidence-based measures. Therefore, the present study aimed to investigate the influencing factors on the tendency of couples to be childless and have only one child. Methods: The present study is the first part of a mixed (qualitative-quantitative) study. The study is qualitative with a conventional content analysis approach. The research population consists of all couples aged 15-49 in 2021 in Babol city, who were single or childless and had no intention of pregnancy in the future. Sampling is based on the purpose, and the number of samples is 40 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Results: The results of the analysis include 140 codes, 30 sub-categories, 9 categories(Economic problems, uncertainty in the future security, threatened priorities, uncertainty about the continuation of life, Fear of becoming a parent, lack of support, diminishing religious beliefs, social role modeling and negative experiences) and two themes. These factors indicate the mandatory conditions for childlessness or one- child choice or voluntary child-free. Conclusion: The results revealed that voluntary childlessness and single-child depend on various aspects. Support of the government, parenting education and efforts to change the attitude of couples by the government can help to improve the health of the family and achieve the goals of population growth policies.

Main actors in the new population policy with a growing trend in Iran: a stakeholder analysis.

The total fertility rate in Iran has declined to below replacement level recently, and a new approach has been taken to tackle this issue. Thus, this study aimed to identify the involved stakeholders and their characteristics in the new population policy change in Iran. We employed a qualitative approach using the purposive sampling of key informants and the identification of relevant documents. The main stakeholders were divided into seven key groups: religious, political, governmental, professional, international sectors, media, and nongovernmental organizations. In addition, there was no centralized, clear, and comprehensive mechanism to guide the activities of stakeholders to coordinate and bring the total fertility rate to the replacement level in Iran. Despite the importance of the new population policy in Iran, in recent years, we still experience dispersion and inconsistency among various actors in this area. It is imperative to go through a consensus and coalition at macro-level authorities alongside evidenced-based population policymaking.

Hospital Expenditure at the End-of-Life: A Time-to-Death Approach.

BACKGROUND: In recent years the use of time to death (TTD) variables in the modeling of individual health expenditures has been of interest to health economics researchers. The aim of this study was to investigate the effect of age and TTD on hospital inpatient expenditure (HIE). METHODS: We used a claims database from Iran Health Insurance Organization of Tehran city that includes considerable proportion of Tehran residents and contains information on insured individuals' HIE. We included HIE of all insured decedents (30 to 90 years old) who died during March 2013 and March 2014 (n=1018). No sampling was required. According to the decedents' date of death, we extracted their last 24 months HIE. The period of time March 30, 2011 until March 30, 2014 (3 years) was used to guarantee a full 24 months of observations for decedents. A two-part econometric model was employed to investigate the effect of age, TTD, and some demographic variables on probability and conditional amount of individuals' hospital expenditure. Stata software (version 16.0) was used for data processing and analysis. RESULTS: Our results demonstrated that the month-based TTDs especially near months before death of decedents (TTD1 to TTD10) significantly affected both probability and conditional amount of HIE. One month before death incurred more HIE than the rest of the months. A further interesting finding is that after including TTD, age variable as a conditional driver of HIE loses its direct effect on decedents' HIE, but age TTD interaction effect on HIE is still positive and statistically significant. CONCLUSION: The results confirm that TTD as a proxy of mortality indicator has a considerable effect on decedents' HIE. The age variable has not directly affected decedents' HIE but indirectly and through its interaction with TTD has a statistically significant effect on HIE. In addition to age, policy-makers should consider TTD to make better predictions of future HIE.

Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households.

OBJECTIVES: Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. METHODS: This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. RESULTS: Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. CONCLUSIONS: In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

Comparison of associated factors of domestic violence against women by their husbands based on demographic characteristics and life skills in Iran.

BACKGROUND: In recent decades, the prevention of domestic violence against women (DVAW) has been considered a priority for women's health in many countries. Identifying factors related to DVAW by their husbands or intimate partner can promise prevention and decrease in prevalence. The objective of this study was to examine and compare associated factors of domestic violence based on demographic characteristics and some life skills. MATERIALS AND METHODS: This cross-sectional study was conducted in Abadan, Iran. 640 couples completed questionnaires including demographic characteristics, communication skills, anger management, and problem-solving skill. In addition, women completed the questionnaire on domestic violence. Data were analyzed using descriptive statistics (t-test and one-way analysis of variance) and multiple linear regression. RESULTS: Approximately 57% of the women in this study have been subjected to psychological violence in their lifetime by their husbands. The result of multiple regression indicated that demographic characteristics had a very small contribution to explaining domestic violence (R 2= 0.03) and only the education level of women was identified as a key predictor of domestic violence. The result of multiple regression based on life skills among couples demonstrated that communication skills and anger management of couples were inversely and significantly associated with domestic violence and these variables explained 51% of the variance in domestic violence. CONCLUSIONS: Empowering couples with anger management and communication skills can play an important role in decreasing domestic violence. Therefore, developing and planning educational interventions by policymakers and health care providers seems necessary for couples.

The Impact of Cancer Incidence on Catastrophic Health Expenditure in Iran with a Bayesian Spatio-Temporal Analysis.

Background: We investigated the impact of cancer incidence on CHE in Iran by considering spatial variation across provinces as well as temporal trends. Methods: Data from Household Income-Expenditure Survey were merged with cancer incidence rates during 2011-2016. We developed a Bayesian hierarchical model to explore the spatial and temporal patterns of CHE and its associated factors at provincial level. We used a Besag-York-Mollie2 prior and a random walk prior for spatial and temporal random effects respectively. All statistical analysis was carried out in R software. Results: All-type cancer incidence (OR per SD (95% CrI) = 1.16 (1.02, 1.32)), unemployment rate (1.08 (1.01, 1.15)) and income equity (0.88 (0.81, 0.97)) have important association with CHE. Percentage of urbanization and percentage of poverty were not statistically significant. Conclusion: The results suggest the development of new policies to protect cancer patients against financial hardship, narrow the gap in income inequality and solve the problem of high unemployment rate to reduce the level of CHE at provincial level.

Healthcare Utilization and Expenditures among Iranian Chemical Warfare Survivors Exposed to Sulfur Mustard.

BACKGROUND: This study aims to explore the healthcare utilization (HCU) and expenditures from complementary health insurance among Iranian people who survived sulfur mustard (SM) exposure during the Iran-Iraq war. METHODS: This study was conducted between March 21, 2018 and March 21, 2019 using secondary data. Data on the HCU and expenditure of war survivors after their exposure to SM were obtained from the Iran Veterans and Martyr Affair Foundation (VMAF) database and the national complementary insurance organization that covers their medical expenses. Multiple linear and zero-inflated poison regression (ZIP) models were used to estimate the costs and HCU. Analyses were performed in R software version 3.6.3. RESULTS: Among 58880 survivors who were included in study, 36383 (61.7%) used at least one service during a year. The total frequency of HCU was 15.6 services per person per year. The annual mean medical cost of each survivor was US$807.6 (±2901.2). The highest number of utilizations was related to medicine and physician visits. The highest median cost was related to rehabilitation (US$151.7), medical equipment (US$84.5), medicine (US$83.3) and inpatient services (US$ 48.8). With increasing age, disability, weight, severity of injury in lung or eye injuries, the rate of health service utilization rose significantly. CONCLUSION: Over 30 years after the Iran-Iraq war, Iranian people who were exposed to SM and survived still suffer from injuries and pose a significant drain on healthcare resources.

Cost of Illness of COVID-19 and Its Consequences on Health and Economic System.

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.

Evaluation of Elderly's Integrated Healthcare components in primary healthcare centers of Tehran, Iran.

BACKGROUND: Over the past few decades, significant demographic and epidemiological changes have been occurred and led to serious changes in the health-care needs of the elderly. Integrated care has been emerged as a strategy to provide better care for the elderly in the community. The aim of this study was conducted to evaluate components of integrated health-care program of the elderly. MATERIALS AND METHODS: This quantitative cross-sectional study was conducted in Tehran (Iran) in 2019. For the purpose of the study, a two-stage cluster sampling method was employed. In the firs stage, primary health-care centers were selected, then in the second stage, a systematic random sampling was conducted based on the number of the elderly covered by each center. level of frailty, medication use awareness, and self-care ability were evaluated by the elderly self-report questionnaire. The questionnaire was piloted with thirty respondents. The test-retest reliability score for the questionnaire was r = 0.795, P < 0.001. Data analysis of the questionnaire was conducted using generalized estimating equation model by SPSS software Version 22. Statistical significance for all analyses was set at P < 0.05. RESULTS: Findings of the components showed that the mean ± standard deviation of frailty (80 ± 17) and self-care ability (87 ± 17) were higher than the mean of medication use awareness (49 ± 19). Frailty and self-care ability (ß = frailty, self-care) of the elderly had a positive statistical significance with the ones with good financial status (ß = 5, 10) and without chronic disease (ß = 4, 5). Medication use awareness had a negative statistical significance with illiteracy (ß = -9.5). CONCLUSIONS: It is suggested that the medication use awareness of the elderly should be prioritized by improving integrated health-care program.