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

Abstract

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.

Health informal payments and their main determinants: The case of Iran

“…[21][22][23]35 One of the most important measures taken to decrease health informal payments in Iran is the HTP, which has been in effect since the beginning of 2014. 36 The most important mechanism used in this plan to reduce the informal payments has been to raise the government' s tariffs and formal payments to physicians. 37 Four years after this plan was implemented, the researchers believed that despite a consequent reduction in the prevalence of health informal payments, such payments are still common in Iran.…”

“…37 Four years after this plan was implemented, the researchers believed that despite a consequent reduction in the prevalence of health informal payments, such payments are still common in Iran. 21,36 Accordingly, it seems that implementing the policy of increasing formal and official health service tariffs alone is insufficient to completely eliminate health informal payments. Other factors affecting the prevalence of health informal payments should also be taken into account.…”

Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran

“…Equitable distribution of health care has been considered as a value in legislation in several countries (3). They try to achieve this through reforms (4)(5)(6), and quantification of the inequalities in using health care to follow the changes after these reforms.…”

Consumer Instigated Unnecessary Medicalization in Iran: A Qualitative Thematic Analysis of the Health Professionals’ Conjectures

“…The available research evidence consistently revealed that utilization of outpatient services were declined in favor of overall increase in health care utilization and inpatient care services (26).…”

“…It is also propounded that a staggering demand exists for some of the medical procedures, among them search for rhinoplasty and caesarean section in case of uncomplicated deliveries are paramount (16,24). Recent revamp in the Iranian national health system (INHS), which had been labeled as health transformation plan (HTP) since its commencement from Oct 2014, was also blamed to have an unfavorable effect on induced health care demands (25,26).…”