Equity in healthcare financing: a case of Iran

Jalali, Faride Sadat; Jafari, Abdosaleh; Bayati, Mohsen; Bastani, Peivand; Ravangard, Ramin

doi:10.1186/s12939-019-0963-9

Cited by 17 publications

(18 citation statements)

References 23 publications

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“…Unlike previous studies in Iran based on 1-year data [ 18 ] or for a single province [ 17 ], our study analyzed the equity in OOP payments for healthcare services and its catastrophic incidence using 6-year annual data points representing the whole Iran and also using WHO standard approach. The overall picture of the total, urban, and rural households’ OOP payments and the incidence of the CHE at different levels of the CTP over time shed light to understand the effectiveness of existing policies in the context.…”

Section: Discussionmentioning

confidence: 99%

“…For example, one study reported a positive KPI and progressive OOP payments for healthcare for the urban residents and a negative KPI and regressive OOP for the rural ones [ 16 ]. 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%

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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: Discussionmentioning

confidence: 99%

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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“…The high inflationary effects of this policy [ 36 ], however, worsened the inequality in health care financing and made access to health care services more limited than before. Reducing the inequality in household OHP was considered auspicious in previous study [ 37 ], but the current study showed that high inequality in health spending was related to affluent families (households with insurance coverage and high-income households) in society. As a result, inequality should be interpreted cautiously in counties with high OHP shares in health care expenditures.…”

Section: Discussionmentioning

confidence: 69%

“…Indicators of inequality in health expenditures have been widely studied by Iranian researchers, but this study is the first to address the issue comprehensively over a 36-year timeframe [ 5 , 21 ]. Mehrolhassani et al [ 22 ] reported that the distribution of health care expenditures was unequal, especially in OHP, with the highest rate ranging from 0.50 to 0.59 during the study timeframe and the disparity index for OHP fluctuating between 37.01% and 65.85%.…”

Section: Introductionmentioning

confidence: 99%

Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households

Aghapour

Basakha

Kamal

et al. 2022

J Prev Med Public Health

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Objectives: Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.Methods: This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.Results: Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.Conclusions: In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

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“…According to the requirements of the fifth and sixth development plans of Iran to reduce out-of-pocket payments, increasing the government's share in financing public health expenses and appropriate allocation of public resources in the health sector is of great importance, and for this reason, providing fair health care services and accessible to the general public has been one of the concerns of the governments of the time and the realization of this goal has always faced serious challenges and obstacles [ 29 ]. The implementation of health system transformation plan in 2014 with the aim of reducing the costs of direct payment from the households' pockets, especially regarding treatment costs in the inpatient and hospital sectors, is considered as one of the important reforms in the Iran health financing system [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

The analysis of National Health Accounts and financial communications network in Iran health insurance ecosystem

Rahimisadegh

Mehrolhassani

Sirizi³

et al. 2022

BMC Health Serv Res

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Background One of the major reforms in the health system of any country is the financing reform. Network analysis as a practical method for investigating complex systems allows distinguishing prominent actors in the relation networks. Leading to the identification of the effective actors and key links between them, the analysis of financial networks helps policymakers to implement reformations by providing appropriate evidence. This study aimed to design and analyze the network of National Health Accounts (NHA) and the cost network in the Iran health insurance ecosystem. Methods The present study is a network analysis study based on the data from NHA, and both cost and referral rates that was conducted in 2021. Data, which was for the years 2014 to 2018 and related to NHA, was collected from the Statistical Center of Iran, and cost data and referral rates, which were both related to Basic Insurance Organizations (BIOs), were collected from statistical yearbooks. To analyze the network and identify the key actors, macro indicators, such as network size and density, and micro indicators, such as centrality indicators and the combined importance index, were used. Results In the financing of the health system in Iran, insurance organizations, as agents and sources of financing, do not have a very good position, so direct payments have become a key element in the network of NHA. Providing treatment-oriented services is quite prior. Regarded to health services, hospitals and outpatient services, such as pharmacies and physicians are the key elements of cost and referral rates respectively. Conclusion Consisting of several organizations with different insurance policies and being supervised under different ministries, Iran's health financing system lacks a coherent structure. It is suggested to create a coherent insurance system by creating a single governance system and paying more attention to health-oriented instead of treatment-oriented services. The health insurance ecosystem has become a health-oriented system to reduce the direct payments as well as cost management.

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Equity in healthcare financing: a case of Iran

Cited by 17 publications

References 23 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

Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households

The analysis of National Health Accounts and financial communications network in Iran health insurance ecosystem

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