It appears that the current method of health financing in Iran does not adequately protect households against catastrophic health expenditure. Consequently, it is essential to reform healthcare financing.

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BackgroundThere are various criteria and methods to develop Basic Health Benefit Package (BHBP) in world health systems. The present study aimed to extract criteria used in health systems in different countries around the world using scoping review method.MethodsA systematic search was carried out in Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, World Bank, World Health Organization, and Google databases between January and April 2016. Papers and reports were gathered according to selected keywords and were examined by two authors. Finally, the criteria were extracted from the selected papers.ResultsThe primary search included 8876 papers. After studying the articles’ titles, abstracts, and full texts, 9 articles and 14 reports were selected for final analysis. After the final analysis, 19 criteria were extracted. Due to diversity of criteria in terms of number and nature, they were divided into three categories. The categories included intervention-related criteria, disease-related criteria, and community-related criteria. The largest number of criteria belonged to the first category. Indeed, the most widely applied criteria included cost-effectiveness (20), effectiveness (19), budget impact (12), equity (12), and burden of disease (10).ConclusionAccording to the results, different criteria were identified in terms of number and nature in developing BHBP in world health systems. It seems that certain criteria, such as cost-effectiveness, effectiveness, budget impact, burden of disease, equity, and necessity, that were most widely utilized in countries under study could be for designing BHBP with regard to social, cultural, and economic considerations.

The present study aimed to investigate the households' impoverishment due to the healthcare costs in Shiraz in 2012. In this household's survey, 800 households were studied in Shiraz. The study sample was selected using stratified and cluster sampling in the urban and rural areas, respectively. The information was collected using the household section of the World Health Survey questionnaire. In order to determine impoverishment due to health spending, at first, the households' food-based poverty line (subsistence expenditure) was measured. Then, households' health expenditure was subtracted from their total expenditure and if the obtained value was lower than the households' food-based poverty line, the households was considered to be impoverished due to health expenditures. The collected data were entered into the SPSS (version 16) statistical software and analyzed using descriptive statistic, Chi-square test, and logistic regression in backward method. The study results showed that 7.1% of the households (CI: 0.071±0.018) were impoverished because of healthcare expenditures. Besides, the households in the first quintile were more likely to be faced with poverty compared to those in the other quintiles (p<0.05). Being covered by health insurance did not affect the protection from poverty due to health costs. Moreover, the participants living in rural areas were faced with poverty more than those living in urban areas (p<0.05). It seems that health expenditure can be an economic shock for household in Shiraz and through spending on health a household may fall into poverty. As insurance had no effect on impoverishment, it implies that change in health insurance plans and ways of health financing is necessary.

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