Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

Rad, Enayatollah Homaie; Khodaparast, Marzie

doi:10.5152/eurasianjmed.2015.32

Cited by 12 publications

(19 citation statements)

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“…Our findings also indicated negative coefficients of the KPIs for the OOP payment for healthcare across the years and the categories, indicating the regressivity of the households’ OOP payments for healthcare services. These findings are consistent with the reports of other several studies [ 6 , 16 – 18 , 27 ]. Another study in Africa also reported a negative coefficient (KPI = − 0.20) of the OOP for healthcare [ 28 ].…”

Section: Discussionsupporting

confidence: 94%

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Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Rezaei

Woldemichael

Ebrahimi

et al. 2020

J. Egypt. Public. Health. Assoc.

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Background Equity in the distribution of health care resources and mitigating the risk of out-of-pocket (OOP) catastrophic healthcare expenditures (CHE) are the major objectives of the health system of a country. This study aims to measure equity in OOP payments for healthcare and the incidence of CHE among Iranian households over time. Methods This retrospective cross-sectional study utilized data extracted from the household income and expenditure survey (HIES) of Iran, collected by the Statistical Center of Iran. The analysis included a total of 174,341 households’ five yearly data of 6 years starting from 1991 to 2017. Kakwani progressivity index (KPI) was used to measure the equity in OOP payment for each year and examine the households’ incidence of CHE at 20%, 30%, and 40% of their capacities to pay (CTP). The trend series regression analysis was used to examine the trend in the KPI and the incidence of the CHE over time. Results The findings indicated that the households’ expenditure on health out of their monthly budgets for the years 1991 and 2017 were 2.1% and 10.1%, respectively. The KPI for the OOP payment was negative for all 6-year observations (1991 = − 0.680; 1996 = − 0.608; 2001 = − 0.554; 2006 = − 0.265; 2011 = − 0.225, and 2017 = − 0.207), indicating that the OOP payments for healthcare are regressive and more concentrated among the socioeconomically disadvantaged households. There was a statistically significant (p = 0.003) increase in the KPI (i.e., decline in the regressivity) over time. The incidence of the CHE (1.12, 1.93, and 3.71%) in 1991 at the CTP levels of 20%, 30%, and 40% was lower than the incidence at the corresponding levels of CTP (5.26, 10.88, and 22.16) in 2017. The findings of the time-series regression indicated a statistically significant (p < 0.05) increase in the incidence of the CHE at the 20%, 30%, and 40% levels of the households’ CTP. Conclusions The current study demonstrated that OOP payment as a source of healthcare funding in Iran is inequitable. While the use of interventions such as the prepaid and publicly funded programs may contribute to the reduction of CHE and improvement of equity in healthcare financing, further inequality analyses in the incidence of the CHE among households and its main determinants can contribute to evidence-informed planning to reduce the CHE in the context.

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Section: Discussionsupporting

confidence: 94%

“…Another study reported a negative (− 0.112) KPI for the healthcare costs (OOP payment for healthcare plus health insurance premiums) [ 17 ]. Besides, the KPI for general taxation and health insurance premiums were progressive and regressive, respectively [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Rezaei

Woldemichael

Ebrahimi

et al. 2020

J. Egypt. Public. Health. Assoc.

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“…Owing to remarkable inequalities in socio-economic development in rural and urban regions of Iran, households’ CTP, average income, and poverty line differ across the areas. Therefore, the gap between households’ CTP in rural and urban areas can be due to more low-income households in rural areas [ 41 ]. According to the findings, health expenditures had increased during the study years in both urban and rural areas.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey

Yazdi‐Feyzabadi

Bahrampour

Rashidian

et al. 2018

Int J Equity Health

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BackgroundHouseholds exposure to catastrophic health expenditure is a valuable measure to monitor financial protection in health sector payments. The present study had two aims: first, to estimate the prevalence and intensity of catastrophic health expenditures (CHE) in Iran. Second, to investigate main factors that influence the probability of CHE.MethodsCHE is defined as an occasion in which a household’s out-of-pocket (OOP) spending exceeds 40% of the total income that remains after subtraction of living expenses. This study used the data from eight national repeated cross-sectional surveys on households’ income and expenditure. The proportion of households facing CHE, as a prevalence measure, was estimated for rural and urban areas. The intensity of CHE was also calculated using overshoot and mean positive overshoot (MPO) measures. The factors affecting the CHE were also analyzed using logistic random effects regression model. We also used ArcMap 10.1 to display visually disparities across the country.ResultsAn increasing number of Iranians has been subject to catastrophic health care costs over the study period in both rural and urban areas (CHE = 2.57% in 2008 and 3.25% in 2015). In the same period, the overshoot of CHE and the mean positive overshoot ranged from 0.26% to 0.65% and from 12.26% to 20.86%, respectively. The average absolute monetary value of OOP spending per month has been low in rural areas over the years, but the prevalence of CHE has been higher than urban areas. Generally put, rural settlement, higher income, receiving inpatient and outpatient services, and existence of elderly people in the household led to increase in CHE prevalence (p < 0.05). Interestingly, provinces with more limited geographical and cultural accessibility had the lowest CHE.ConclusionsAccording to the findings, Iran’s healthcare system has failed to realize the aim of five-year national development plan regarding CHE prevalence (1% CHE prevalence according to the plan). Therefore, revision of financial health care protection policies focusing on pre-payments seems mandatory. For instance, these policies should extend the interventions that target low-income populations particularly in rural areas, provide more coverage for catastrophic medical services in basic benefit packages, and develop supplementary health insurance.

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“…In recent years, the Iranian health system has suffered from problems such as high out-of-pocket (OOP) spending and a higher than desirable rate of households faced with catastrophic health expenditures (CHE) [ 1 ]. Despite adopting several reforms, such as developing and implementing a rural family physician program, a rural insurance plan, and comprehensive national health insurance, there are still concerns about equitable and progressive financial protection and equitable access to health care [ 2 ]. For instance, a study on national health accounts showed that OOP spending increased from 40.63 to 54.64% between 2008 and 2014 [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level

et al. 2017

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OBJECTIVESThe health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program’s important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis.METHODSData on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated.RESULTSOverall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%).CONCLUSIONSThe reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.

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Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

Cited by 12 publications

References 18 publications

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level

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