Health Financing Reforms for Moving towards Universal Health Coverage in the Western Pacific Region

Chu, Annie; Kwon, Soonman; Cowley, Peter

doi:10.1080/23288604.2018.1544029

Cited by 44 publications

(43 citation statements)

References 28 publications

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“…The sources to healthcare financing in many countries included general taxation, social health insurance, private health insurance, community financing, and out-of-pocket (OOP) payments [ 7 ]. In under-resourced countries like Iran, OOP healthcare financing is a major source of funding [ 8 , 9 ]. In Iran, the OOP payment accounted for more than 50% of the total healthcare expenditure of the country [ 10 ] which is higher than the values reported for other countries [ 11 ].…”

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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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: 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.

View full text Add to dashboard Cite

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“…Therefore, integrating insurance funds or consolidating small insurance ones can be among policy options to improve this situation. The participants also discussed that the current fragmentation had reduced e ciency and capacity for cross-subsidization, as mentioned in previous evidence [41,42].…”

Section: Pooling Of Fundsmentioning

confidence: 86%

Recommendations to improve insurance coverage for physiotherapy services in Iran: A multi-criteria decision making approach

Shahabi

Heydari

Lankarani

et al. 2020

Preprint

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Background: High toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and prioritized potential policy recommendations to improve insurance coverage for physiotherapy services in Iran.Methods: This project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time. Results: Within the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g. informing policy-makers about physiotherapy services), collection of funds (e.g. placing value-added taxes on luxury goods and services), pooling of funds (e.g. moving allocated resources towards insurance [viz. third-party] mechanism), purchasing (e.g. using strategic purchasing), and benefit package (e.g. considering preventive interventions) as the main components of insurance coverage. Conclusion: The study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.

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“…Therefore, integrating the insurance funds or consolidation the small insurance funds can be policy options to improve this situation. Participants were discussed that current fragmentation has reduced efficiency and capacity for cross-subsidization, as mentioned in previous evidence [35,36].…”

Section: Pooling Of Fundsmentioning

confidence: 99%

Recommendations to improve the insurance coverage for physiotherapy services in Iran A multi-criteria decision making approach

Shahabi¹,

Heydari²,

Lankarani³

et al. 2020

Preprint

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Background High rate of traffic injuries, climate changes, natural disasters, aging, and chronic diseases have been resulted in a considerable demand for receiving physiotherapy in Iran. However, there are various complications in utilization of physiotherapy services, especially poor insurance coverage. This study investigated and prioritized potential policy recommendations to improve the insurance coverage for physiotherapy services in Iran. Methods The present project was carried out using mix-method (qualitative-quantitative) approach in Iran. In the first phase, a qualitative study was conducted to find the policy recommendations and in the second phase, obtained policy recommendations were prioritized based on the effectiveness, acceptability, cost, fairness, feasibility, and time using Analytical Hierarchy Process (AHP). Results In the first phase, 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were conducted. Several policy recommendations were proposed by participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g. informing the policy-makers about physiotherapy services), collection of funds (e.g. value-added tax on luxury goods and services), pooling of funds (e.g. moving the allocated resources to insurance (third party) mechanism), purchasing (e.g. using strategic purchasing), and benefit package (e.g. considering the preventive interventions) as main components of insurance coverage. Conclusion The findings of this study will be provided a favorable ground to improve the insurance coverage for physiotherapy services in Iran, and decision- and policy-makers can place these recommendations at their agenda settings in the health sector to protect the health status of population, especially disabled groups.

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Health Financing Reforms for Moving towards Universal Health Coverage in the Western Pacific Region

Cited by 44 publications

References 28 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

Recommendations to improve insurance coverage for physiotherapy services in Iran: A multi-criteria decision making approach

Recommendations to improve the insurance coverage for physiotherapy services in Iran A multi-criteria decision making approach

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