Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

Moradi, Tayebeh; Naghdi, Seyran; Brown, Heather; Ghiasvand, Hesam; Mobinizadeh, Mohammadreza

doi:10.1002/hpm.2517

Cited by 22 publications

(32 citation statements)

References 23 publications

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“…Boing et al found that the poorest households and households headed by the leasteducated individuals significantly contribute to increasing social inequality [24]. Moradi et al showed that income is the most significant determinant of inequality in facing CHE [25]. Wang et al used a nationally representative dataset and found that household size, per capita income, family members above 65 years of age, and family members with two or more chronic diseases significantly increase CHE inequality [26].…”

Section: Introductionmentioning

confidence: 99%

Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

liu

Zhu

Wang

et al. 2019

Preprint

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Introduction: By 2013, several regions in China have introduced health insurance integration policies. However, few studies have addressed the impact of medical insurance integration in China. This study investigates catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated areas and non-integrated areas in China in 2013. Methods: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose the inequality of the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is -0.071 and -0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than in non-integrated areas. However, households in integrated areas have lower out-of-pocket expenditures share in capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. However, compared with non-integrated areas, the inequity caused by integrated medical insurance has been significantly reduced in integrated areas. Conclusions: The medical insurance integration system in China is still at the exploring stage; hence, its effects are of limited significance. Regardless of the area, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and the use of health services significantly affect the equity of catastrophic health expenditure incidence. Keywords: Catastrophic health expenditure, Medical insurance integration system, Equity, Influencing factors

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Section: Introductionmentioning

confidence: 99%

Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

liu

Zhu

Wang

et al. 2019

Preprint

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“…The increase of outpatient OOP, where Rad et al (2017) reported signi cant increase of OOP payments for outpatient care services increased after the HTP, which in uenced the total OOP (17). In addition, despite the increase in the share of health from GDP after the HTP in Iran, catastrophic and impoverishment expenditures have not decreased su ciently to achieve the goals of the HTP in term of the nancial risk protection (50).…”

Section: Discussionmentioning

confidence: 99%

Economic Burden of Cardiovascular Diseases Before and After the Iran’s Health Transformation Plan: A Cross-Sectional Study on Referral Hospital in the North-West of Iran

Alipour

Zandian

Yazdi‐Feyzabadi

et al. 2020

Preprint

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BackgroundDifferent countries have set different policies to control and decrease the costs of Cardiovascular Diseases(CVDs). Iran aiming reducing the economic burden of different disease by a recent reform from named as health transformation plan(HTP). This study aimed to examine economic burden of CVDs before and after of HTP, MethodsThis cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran's Ministry of Cooperatives, Labor, and Social Welfare, central bank of the Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials(IRR). ResultsTotal costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after(62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p=0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2% to 36.7%. All hospitalization costs, except patients' OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively. ConclusionThe economic burden of CVDs after the HTP increased in the north-west of Iran due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to

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“…This analysis presents changes in the level and distribution of OOP payments and catastrophic health expenditure after the implementation of the HTP. Previous studies estimated the impact of HTP on OOP payments by using different methodologies and thresholds . The methodology used in the current study is described in the 2017 global monitoring report on progress towards UHC, which is more relevant to health reforms aimed at reaching universal health coverage.…”

Section: Discussionmentioning

confidence: 99%

The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications

Ahmadnezhad

Murphy

Alvandi

et al. 2019

Health Planning & Management

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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.

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Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

Cited by 22 publications

References 23 publications

Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

Economic Burden of Cardiovascular Diseases Before and After the Iran’s Health Transformation Plan: A Cross-Sectional Study on Referral Hospital in the North-West of Iran

The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications

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