A Description of the Temporal Pattern of Out-of-Pocket Expenditure Related to Iranian Healthcare Services during 1995-2014

  • Masoud BEHZADIFAR Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  • Tina BEYRANVAND Dept. of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
  • Mehdi JAFARI Dept. of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
  • Meysam BEHZADIFAR Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
  • Masood TAHERI MIRGHAED Dept. of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
  • Mariano MARTINI Dept. of Health Sciences (DISSAL), Section of History of Medicine and Ethics, University of Genoa, Genoa, Italy
  • Nicola Luigi BRAGAZZI Dept. of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
Keywords: Healthcare reforms, Health economics, Iran, Out-of-pocket expenditure

Abstract

Abstract Background: Out-of-pocket (OOP) expenditure directly impacts on poverty and household welfare, especially when there is a decline in healthcare financing. This study was aimed to describe the temporal pattern of OOP expenditures related to Iranian healthcare services during 1995-2014. Methods: For describing the trend of OOP spending in Iran, the database of the World Bank was mined for the period under study. Further, the trend analysis has been complemented by an exhaustive and comprehensive review of the extant literature. Results: From 1995 to 2014, out-of-pocket decreased from 53.59% to 47.8% of the total health expenditure, probably because of the different health reforms implemented throughout the years. However, out-of-pocket expenditure in Iran remains higher than the world average (roughly 3 times higher) Conclusion: It is an onus of the Iranian government to make serious attempts in order to reduce out-of-pocket expenditure, as well as to protect particularly poor and vulnerable subjects against catastrophic health expenditure. In order to ensure an equitable and affordable access to the healthcare system, decision- and policy-makers in Iran should implement a review of health care costs, insurance tariffs, and healthcare services packages covered by insurance organizations as well as introduce a progressive tax-based financing scheme as soon as possible.  

References

1. Regional health Systems Observatory and World Health Organization (WHO) (2006) Health System Profile: Islamic Republic of Iran. http://apps.who.int/medicinedocs/documents/s17294e/s17294e.pdf
2. World Health Organization(WHO) (2000). The world health report 2000 - Health systems: improving performance. http://www.who.int/whr/2000/en/
3. Du L, Lu W (2016). Bloomberg News. U.S. Health-Care System Ranks as One of the Least-Efficient. America is number 50 out of 55 countries that were assessed. http://www.bloomberg.com/news/articles/2016-09-29/u-s-health-care-system-ranks-as-one-of-the-least-efficient
4. The Constitution of the Islamic Republic of Iran (2017). http://www.wipo.int/edocs/lexdocs/laws/en/ir/ir001en.pdf
5. Dodd R, Cassels A (2006). Health, development and the Millennium Development Goals. Ann Trop Med Parasitol, 100:379-87.
6. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ (2003). Household catastrophic health expenditure: a multicountry analysis. Lancet, 362:111-17.
7. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T (2007). Protecting households from catastrophic health spending. Health Aff (Millwood), 26:972-83.
8. Mullahy J (2009). Econometric modeling of health care costs and expenditures: a survey of analytical issues and related policy considerations. Med Care., 47:S104-8.
9. Whitehead M, Dahlgren G, Evans T (2001). Equity and health sector reforms: can low-income countries escape the medical poverty trap? Lancet, 385:833-6.
10. Roy K, Howard DH (2007). Equity in out-of-pocket payments for hospital care: evidence from India. Health Policy, 80:297-307.
11. The World Bank (2017) Out-of-pocket health expenditure (% of total expenditure on health). https://www.indexmundi.com/facts/indicators/SH.XPD.OOPC.TO.ZS
12. Homaie Rad E, Vahedi S, Teimourizad A, Esmaeilzadeh F, Hadian M, Torabi Pour A (2013). Comparison of the Effects of Public and Private Health Expenditures on the Health Status: A Panel Data Analysis in Eastern Mediterranean Countries. Int J Health Policy Manag, 1:163-167.
13. Marzban S, Rajaee R, Gholami S, Keykale MS, Najafi M (2015). Study of Out-of-Pocket Expenditures for Outpatient Imaging Services in Imam-Khomeini Hospital in 2014. Electron Physician, 7:1183-9.
14. Abolhallaje M, Hasani S, Bastani P, Ramezanian M, Kazemian M (2013). Determinants of catastrophic health expenditure in Iran. Iran J Public Health, 42:155-60.
15. Zakeri M, Olyaeemanesh A, Zanganeh M et al (2015). The financing of the health system in the Islamic Republic of Iran: A National Health Account (NHA) approach. Med J Islam Repub Iran, 29:243.
16. Ghiasvand H, Naghdi S, Abolhassani N, Shaarbafchizadeh N, Moghri J (2015). Iranian Households' Payments on Food and Health Out-of-Pocket Expenditures: Evidence of Inequality. Iran J Public Health, 44:1103-13.
17. Pourasghari H, Jafari M, Bakhtiari M, Keliddar I, Irani A, Afshari M (2016). Analysis of equality in Iranian household healthcare payments during Iran's fourth development program. Electron Physician, 8:2645-9.
18. Fazaeli AA, Hadian M, Rezapour A, Fazaeli AA (2016). Assessing the Distribution of Household Financial Contribution to Health System: A Case Study of Iran. Glob J Health Sci, 8:55911.
19. Vosoogh Moghaddam A, Damari B, Alikhani S et al (2013). Health in the 5th 5-years Development Plan of Iran: Main Challenges, General Policies and Strategies. Iran J Public Health, 42:42-9.
20. Rezapour A, Ebadifard Azar F, Azami Aghdash S, Tanoomand A, Ahmadzadeh N, Sarabi Asiabar A (2015). Inequity in household's capacity to pay and health payments in Tehran-Iran-2013. Med J Islam Repub Iran, 29:245.
21. Rezapour A, Arabloo J, Tofighi S et al (2016). Determining Equity in Household's Health Care Payments in Hamedan Province, Iran. Arch Iran Med, 19:480-7.
22. Takian A, Akbari-Sari A (2016). Sustainable Health Development Becoming Agenda for Public Health Academia. Iran J Public Health, 45:1502-1506.
23. Piroozi B, Moradi G, Nouri B, Mohamadi Bolbanabad A, Safari H (2016). Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran. Int J Health Policy Manag, 5:417-423.
24. Ghiasvand H, Abolghasem Gorji H, Maleki M, Hadian M (2015). Catastrophic Health Expenditure Among Iranian Rural and Urban Households, 2013 - 2014. Iran Red Crescent Med J, 17:e30974.
25. Montazeri A, Riazi-Isfahani S, Damari B (2016). How to integrate social care services into primary health care? An experience from Iran. Med J Islam Repub Iran, 30:408.
26. Nosratnejad S, Rashidian A, Dror DM (2016). Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries. PLoS One, 11:e0157470.
Published
2018-10-06
How to Cite
1.
BEHZADIFAR M, BEYRANVAND T, JAFARI M, BEHZADIFAR M, TAHERI MIRGHAED M, MARTINI M, BRAGAZZI NL. A Description of the Temporal Pattern of Out-of-Pocket Expenditure Related to Iranian Healthcare Services during 1995-2014. IJPH. 47(10):1552-7.
Section
Original Article(s)