Fairness of Health Financing before and after Introduction of Iranian Health Sector Evolution Plan: A Case StudyCorrespondence Address :
Dr. Mohammad-Hasan Imani-Nasab,
Assistant Professor, School of Health and Nutrition, Karimkhan Zand Avenue, Goldasht Shargi, Khorramabad, Lorestan,
Pin- 6813833946, Iran.
Introduction: Since out-of-pocket payments of household are a serious obstacle to the equitable utilization of health services, paying attention to the direct payment of households and, consequently, incidence of catastrophic health expenditures should always be considered in the planning and policy-making of health services. Iranian Health Sector Evolution Plan (HSEP) has been implemented since 2014, aiming at achieving universal coverage of health services and reducing the amount of out-of-pocket payments as a percentage of total health expenditures.
Aim: To measure the fairness of health care financing and to identify incidence rate of catastrophic health expenditures and its most important determinants before and after implementing the HSEP among households in one province of Iran (Lorestan).
Materials and Methods: The study population of present cross-sectional research was Lorestan households whose information was collected by a three-stage randomized cluster sampling method by the Statistics Center of Iran during 4/2012-3/2015. For data analysis, Logitís regression model using Stata14 software was performed.
Results: Based on the findings between 4/2012 and 3/2015, the incidence rate of Catastrophic Health Expenditure (CHE) reduced from 6.7 to 4.34; Fairness Financial Contribution Index (FFCI) varied from 0.66 to 0.74 and percentage of poverty due to health expenditure varied from 1.96% to 0.28%. The most important determinants of facing catastrophic health expenditure are economic status of households, location of households (urban or rural), and number of people over the age of 65 and under the age of 5 in the household, age and sex of household head and insurance status of households. The use of health care also showed a significant relationship with the incidence of catastrophic health expenditure.
Conclusion: After implementing Iranian HSEP, the incidence of CHE and the percentage of poverty caused by health expenditure at the level of households were reduced to some degree, and fairness financial contribution index improved. The finding of this study will help health policymakers to identify factors increasing the likelihood of household exposure to catastrophic health expenditure, and based on these factors, to review and revise the programs implemented within the framework of Iranian HSEP and adopt appropriate policies to promote the protection of households against catastrophic health expenditure.
Catastrophic Health Expenditure, Fairness Financial Contribution Index, Equity, Health Sector Evolution Plan
Soraya Nouraei Motlagh, Banafsheh Darvishi, Payam Haghighatfard, Mohammad-Hasan Imani-Nasab. FAIRNESS OF HEALTH FINANCING BEFORE AND AFTER INTRODUCTION OF IRANIAN HEALTH SECTOR EVOLUTION PLAN: A CASE STUDY. Journal of Clinical and Diagnostic Research [serial online] 2018 June [cited: 2018 Aug 16 ]; 12:IC10-IC15. Available from
Date of Submission: Dec 30, 2017
Date of Peer Review: Feb 27, 2018
Date of Acceptance: Apr 10, 2018
Date of Publishing: Jun 01, 2018
FINANCIAL OR OTHER COMPETING INTERESTS: None.
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