Extended Abstract
Introduction: Providing the necessary ground for economic growth and development is one of the main goals of policymakers, experts and managers of all governments, especially in developing countries, such as Iran. In this regard, firstly, factors necessary for economic growth and development should be identified and then conditions should be prepared for acceleration of growth and development by promoting and improving situation of these factors. In economic growth literature, physical capital, human capital, and technology have been introduced as the main factors of growth. Although better life or welfare can be understood in different ways, it is necessary to pay attention to people’s health and livelihoods so as to let them take advantage of economic development and motivation to move forward with development (Langlois and et al., 2012). For example, when the workforce plays a role in the production process with all power that expected continue to live after retirement for significant years, and will have the opportunity and health to take advantage of this hard work (Maclean et al., 2015).
Improving health and providing health services is an essential aspect of socio-economic development, since health and well-being are can be referred to as a basic aspect of life quality. Therefore, the purpose of this study was to investigate factors affecting decision making of Iranian households living in the deprived provinces to enter the health market.
Method: In this study, sample selection models and Hackman’s two-step estimation method were used to identify the factors influencing household decision making. It is worth noting that given the difficulty in choosing a sample, it is necessary to use sample selection models to obtain reliable estimates. In this study, household budget information from the Statistical Center of Iran, and data on 6940 households living in deprived provinces and 15324 households living in relatively deprived provinces were used.
In this study, STATA software, version 11 was used to examine the factors affecting decision making of Iranian households living in the deprived provinces to enter healthcare market. The reason for choosing the software was its proper features and popularity. In the present study the following hypotheses was examined:
- Economic factors (income and insurance) affect decision making of Iranian households living in the deprived provinces to enter healthcare market.
- Social factors (education, marital status, smoking, developmental level and urbanization) affect decision making of Iranian households living in the deprived provinces to enter healthcare market.
- Demographic factors (family size, gender, age structure) affect decision making of Iranian households living in the deprived provinces to enter healthcare market.
Documentary method was used in this study to collect statistical data. Table 1 shows variables and their references:
Table (1) Research Variables
Factors    Number    Variable Name    References
Dependent Variable    1    Health Costs    Giammanco and Gitto, 2019
Malik and Syed, 2012
Matsaganis and et al., 2009
Economic Factors    2    Income    Cuckler and et al., 2018
Lisboa and et al., 2013
Balarajan and et al., 2011
    3    Insurance    Cuckler and et al., 2018
Brown and et al., 2014
Social Factors    4    Education    Lisboa and et al., 2013
Malik and Syed, 2012
Balarajan and et al., 2011
    5    Marital Status    Lisboa and et al., 2013
Malik and Syed, 2012
    6    Smoking    Huang and et al., 2017
Balarajan and et al., 2011
    7    Developmental Level and Urbanization    Brown and et al., 2014
Malik and Syed, 2012
Balarajan and et al., 2011
Demographic Factors    8    Family Size*    Brown and et al., 2014
Malik and Syed, 2012
Balarajan and et al., 2011
    9    Gender    Lisboa and et al., 2013
Malik and Syed, 2012
Matsaganis and et al., 2009
    10    Age Structure*    Brown and et al., 2014
Malik and Syed, 2012
Matsaganis and et al., 2009
* Indicators relating to family size and age structure are commonly and considered “number of children”, “number of young people”, “number of elderly”, and “number of non-elderly”.
Findings: The present study classified a quantitative research according to problem nature and its data. Although some descriptive statistics are used in this study, the main method of analysis was parametric type of inferential statistics, and studying the effects of factors impacting on decision making of Iranian households living in the deprived provinces to enter healthcare market using regression.
Considering the sample composition in terms of households entering health market, sampling models can be suitable for estimating health care costs of households living in deprived provinces. In other words, the high percentage of households who has not entered the healthcare market led to a non-random sample.
The results of sample selection model with the Hackman’s two-step method are indicated in Table (2):












Table (2) The Results of Sample Selection Model (Dependent variable: the Amount of Health and Medical Costs- entering the Health Market)
P-Value    Coefficient    Equation    P-Value    Coefficient    Variable    Equation
0.000    0.15    Selection Equation    0.297    11436.3    Gender    Outcome Equation
0.043    -0.03        0.002    -14060.7    Marital Status    
0.000    0.12        0.003    20895.9    Insurance    
-    -        0.000    0.004    Income    
0.099    0.03        0.000    24916.5    Education    
0.000            0.003    0.04    Smoking    
0.000    0.08        -    -    Number of Children    
0.000    0.02        -    -    Number of Young    
0.000    0.16        0.000    28222.2    Number of Elderly    
-    -        0.001    6034.9    Number of Non-Elderly    
0.000    -0.12        0.000    -23360.2    Urbanization    
0.000    0.25        0.003    33874.7    Developmental Level    
0.000    -0.39        0.016    -184696.6    Constant    
            0.005    214610.6    
            0.000    135.05    





The reported Wald’s statistics in Table (2) shows that regression is significant, so it can be said that economic, social, and demographic variables can be explain changes in the health and medical costs of Iranian households living in deprived and relatively deprived provinces.
Discussion: The results show that gender, health insurance services, smoking costs, number of children, the youth and elderly, urbanization, and the level of province development are the most important factors impacting on decision making of households living in deprived and relatively deprived provinces to enter the health market (the coefficients are significant at all three levels of 1%, 5% and 10%). Also, the head of household marital status (that is significant at levels of 5% and 10%) and education (that is significant at levels of 10%) are other factors that can affect decision making of households living in deprived and relatively deprived provinces.
As explained, in the Hackman’s two-step method, the selection equation estimated using Probit method, so the coefficients of this equation differ with marginal effects; thus they have not numerical interpretation capability. Accordingly, the analysis related to this equation is limited to expressing how communication (direct or reverse) between explanatory variables and probability of households enter the health market.
In order to ensure that households living in the deprived provinces have appropriate health and treatment conditions, more health care products and services in these areas should be provided, especially in rural areas; at various educational levels, health promotion should be considered as culture and; and insurance plans should be focused on covering all members of the community.





Ethical Considerations
Funding
This article has been edited from the doctoral dissertation and is subject to regulations. All stages of publication have been coordinated by the supervisor, but there has not been direct financial support for the publication of this article from any organization or institution.
Authors’ contributions
All authors contributed in designing, running, and writing all parts of the research.
Conflicts of interest
The supervisor of the doctoral thesis is the author of this article and the student under his supervision has written it. The consultant professors in the treatise also contributed effectively to the authors of the paper.
Acknowledgments
In this article, all rights relating to references are cited and resources are carefully listed.