Background Ensuring financial protection of the community against health care expenditures is one of the fundamental goals of the health system. Catastrophic health expenditures (CHE) occurs when out-of-pocket health expenditures due to health care expenses considerably affect family life. The main purpose of this study was to analyze CHE trend over time and to determine its determinants. Methods The last round of a three part study over time was conducted in June to September 2015 on 600 households in a non-affluent area of Tehran. The World Health Survey questionnaire was used to collect information. Health expenditure was considered to be catastrophic when OOP health expenditures exceed 40% of household’s capacity to paysubsistence expenditures. After calculating the amount of households’ exposure to CHE, determinants resulting in CHE using logistic regression and the amount of economic inequality in the exposure of households to CHE using the concentration index were calculated. Then, performing a decomposition analysis, the contribution of each of the studied variables to the observed economic inequality was determined. All the findings were compared with the results of studies carried out in the years 2003 and 2008. Results In the year 2015, 29.9% of households incurred CHE. This amount was 12.6 and 11.8% in the 2003 and 2008 studies, respectively. The concentration index was - 0.017(confidence interval; − 0.086 to 0.051), which, unlike the CI calculated in the years 2003 and 2008, was not significant. The most important determinant affecting the exposure to CHE was inpatient service utilization (OR = 1.64). Conclusion Comparing to the whole national wide findings in sum, in 2015, the amount of the exposure of the studied households to CHE was significant, and it in comparison with the results of the previous studies was increased. However, there was no significant economic inequality and the observed levels of inequalityin comparison with the results of the previous studies conducted in 2003 and 2008 were decreased.

Background: One of the 3 main goals of any health system is to meet the non-medical expectations of individuals while interacting with health system. The purpose of this study is to evaluate the health system responsiveness before and after the implementation of the health transformation plan (HTP) in Iran. Methods: In this longitudinal study, a household survey was conducted at the district 17 of Tehran, Iran in 2003, 2008. A sample of 600 families was selected using a two-stage cluster sampling approach. Data were collected using a questionnaire and face-to-face interview. Chi square and One Way Anova were used to analyze the data in the SPSS 16. Results: The importance of all dimensions of responsiveness has decreased compared to previous years in 2015. Dignity (83.46%) had the best performance (high score) and choice (69.23%) had the worst performance (low score) in outpatient services. The best performance score was confidentiality (81.7%) in inpatient services and the worst was autonomy (67.76%). Private centers performed better than other centers in all dimensions of responsiveness. This difference was statistically significant in outpatient services (P value < 0.05) and was significant in inpatient services only in 2001. Principal component analysis found for out-patient care responsiveness are 2 main factors explaining 69.5% of the variance and for in-patient care responsiveness 1 factor explaining 91.7% of the variance. Overall responsiveness level has increased. Conclusions: Given the increasing level of responsiveness in outpatient and inpatient services after the implementation of the HTP, it can be concluded that this plan has been effective. Interaction of patients and service providers is an issue that should be addressed by health sector reform.

Public health strategies and preventive policies should be focused on more common human risk factors such as disregarding traffic rules and regulations, drivers' rushing, and alcohol consumption due to their greater population attributable fraction and more intuitive impacts on society.

OBJECTIVESThe aim of this study was to measure income-related inequality in completed suicide across the provinces of Iran.METHODSThis ecological study was performed using data from the Urban and Rural Household Income and Expenditure Survey-2010 conducted by the Iranian Center of Statistics, along with data on completed suicide from the Iranian Legal Medicine Organization in 2012. We calculated the Gini coefficient of per capita income and the completed suicide rate, as well as the concentration index for per capita income inequality in completed suicide, across the provinces of Iran.RESULTSThe Gini coefficients of per capita income and the completed suicide rate in the provinces of Iran were 0.10 (95% confidence interval [CI], 0.06 to 0.13) and 0.34 (95% CI, 0.21 to 0.46), respectively. We found a trivial decreasing trend in the completed suicide incidence rate according to income quintile. The poorest-to-richest ratio in the completed suicide rate was 2.01 (95% CI, 1.26 to 3.22). The concentration index of completed suicide in the provinces of Iran was -0.12 (95% CI, -0.30 to 0.06).CONCLUSIONSThis study found that lower income might be considered as a risk factor for completed suicide. Nonetheless, further individual studies incorporating multivariable analysis and repeated cross-sectional data would allow a more fine-grained analysis of this phenomenon.

In the original publication of this article [1], the title should be revised as blow: