Summary Purpose In 2014, the Islamic Republic of Iran launched the Health Transformation Plan (HTP), with the goal of achieving universal health coverage (UHC) through improved financial protection and access to high‐quality health services among Iranian households. We aimed to investigate the impact of the HTP on the level and pattern of out‐of‐pocket (OOP) payments for health care. Methods Using data from two rounds (2013 and 2016) of the Iranian Statistics Centre's Household Expenditure and Income Survey (HEIS), collected before and after implementation of the HTP, we estimate changes in the level and drivers of OOP payments, and the prevalence, intensity, and distribution of catastrophic health expenditures (CHEs) among Iranian households. Findings Our results indicate that per capita OOP payments on health remained stable during the observed period, with the largest proportion of OOP payments spent on medicines. Using thresholds of 10% and 25% of total consumption, there was a slight increase in the prevalence of CHE. The prevalence of CHE increased from 3.76% to 3.82% at threshold of 25% of total consumption. Using 40% capacity to pay threshold, prevalence diminished modestly from 2.5% to 2.37% and the intensity decreased from 13.16% to 12.32%. At all thresholds, CHE were more concentrated among wealthier households. Conclusion These results suggest that while financial protection of the poor in Iran has improved due to the HTP, more work is needed to achieve UHC in Iran. For the next phase of health reforms, more emphasis should be placed on shifting away from OOP co‐payments for health financing to progressive prepayment mechanisms to facilitate better sharing of financial risks across population groups.

Background: The aim of this study was to evaluate the health status of Iranians following the sustainable development goals (SDGs) introduction and to compare with those of the Middle East and North Africa region (MENA) and global. Methods: This comparative study used secondary data analysis to investigate socio-demographic and health status indicator. The sources included census, population-based surveys and death registries. The indicators in MENA were obtained from international databases including WHO, the World Bank and the Institute for Health Assessment and Evaluation (IHME). Results: Life expectancy and human development index increased following the HTP implementation. Among causes of death, 74.6% were attributed to non-communicable diseases (NCDs). There was an increasing trend in risk factors for NCDs in Iran, while at the same time Neonatal, infant and under-5 mortality rates reduced. Compared to the MENA, Iran has a lower maternal mortality ratio, neonatal, infant, and under-5 mortality rates, and a higher life expectancy. NCDs and road injuries accounted for a larger portion of disability-adjusted life years in Iran compared to the MENA and worldwide. Conclusion: Actions against communicable diseases and road traffic injuries are required together with continued efforts to address NCDs. Although Iran does not have a low global SDGs Index ranking, there is a need to develop a roadmap to accelerate achieving global health goals and SDGs implementation.

Introduction: One of the most important 2015-post agendas of countries’ health systems is achieving Universal Health Coverage (UHC), so countries should monitor the activities carried out. The present study aimed to investigate the UHC status two years after Health Transformation Plan (HTP) in Iran. Methods: This is a secondary analysis of the national household income and expenditure survey (with close 40,000 households as the survey sample). The survey was used to estimate financial protection indicators (out-of-pocket payment, catastrophic and impoverishment health expenditure) in 2016. Estimation for service coverage index provided by international databases was applied at the country level. Indicators of financial protection and service coverage were evaluated in relation to each other using the World Health Organization joint levels assessment method, which indicates UHC attainment in terms of a plot with four zones. The relationship was estimated for the entire population, first quintile, and fifth quintile in 2000, 2017, and 2030. Results: The average per capita of OOP annually was 1,940,613 Rials (162.415 PPP int $). About 15.85% of households endured catastrophic health expenditures at the 10% threshold. The impoverishment health expenditure is about 0.6. Accordingly, Iran is on the border between zones 1 and 2 in 2017 in terms of achieving UHC and will move to zone 1 in 2030 with the current trend. Conclusion: According to the results of this study, universal health coverage has not been achieved even despite the implementation of the HTP. Even with improved service coverage, achieving UHC by 2030 may seem impossible with the current trends.

Introduction Iran launched a series of health reforms called Health Transformation Plan (HTP) in order to improve financial protection and access to health care in 2014. This study aimed to investigate the extent of impoverishment due to out of pocket (OOP) payments during 2011–2016 and to assess the implications of health expenditures to overall national poverty rate before and after the HTP implementation, with a focus on monitoring the first Sustainable Development Goals (SDGs). Methods The study relied on data from a nationally representative household income and expenditure survey. Two measures of poverty were estimated in this study: the prevalence (poverty headcount) and the intensity of poverty before and after OOP health payments (poverty gap). Proportion of the population fell into poverty due to OOP spending for health care from total poor population calculated for 2 years before and after the HTP implementation using three poverty lines suggested by the World Bank for global poverty comparison ($1.90, $3.2 and $5.5 per day in 2011 purchasing power parity (PPP) $). Results Our results indicate that the incidence of impoverishing health expenditures has remained relatively low during 2011–2016. At the 2011 PPP $5.5 daily poverty line, the average incidence rate at the national level was 1.36% during the period. The percentage of population impoverished due to OOP health expenditures increased after HTP implementation, irrespective of the poverty line used. However, the proportion of individuals that pushed further into poverty decreased after HTP implementation. It was estimated that around 12.5% of total poor population fell below poverty line due to paying OOP payments in 2016. Conclusion Although health care costs are not major causes of impoverishment in Iran, the relative impact of OOP spending for health is not negligible. To attain SDG 1, pro‐poor interventions that aim to reduce the burden of OOP payments should be advocated and implemented with an inter‐sectoral approach.