The Effect of Iran Health Transformation Plan on Equity in Health Financing: A Systematic Review
Abstract
Background: Achieving financial goals is one of the health systems goals, especially for those in low- and middle-income countries. Since financing equity, is an objective of Health Transformation Plan (HTP) implementation in Iran, this study examined this plan toward improving equity in healthcare Financing, using four payment indices: Out-of-Pocket Payment (OOP), Catastrophic Health Expenditure (CHE), Fair financial Contribution Index (FFCI) and Impoverishing Health Expenditure (IHE).
Methods: Articles published in English on equity in financing related to HTP were searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between Jan 2014 and Dec 2020, following PRISMA guidelines. Overall, 1319 papers were retrieved initially, and 31 were selected for analysis.
Results: After implementation of HTP, OOP index has decreased between patients and households. No consistent trend was evident for CHE. HTP reforms have a limited effect on the FFCI. The one study on IHE has shown an upward trend for this index. In general, in the early years of HTP, there was a higher downward trend in equity in financing indicators than in subsequent years.
Conclusion: HTP has made significant accomplishments in equity, such as the financial protection of patients in healthcare centers, but fail to achieve this plan goals, significantly reduced its value. Therefore, it is necessary for managers and health policy makers around the world, with scientific and principled solutions, to prevent loss of their reform plans positive achievements.
1. Tabari-Khomeiran R, Delavari S, Rezaei S, Rad EH, Shahmoradi M (2019). The ef-fect of Iranian health system reform plan on payments and costs of coronary ar-tery bypass surgery in private hospitals of Iran. Int J Hum, 10.1108/IJHRH-07-2018-0047.
2. Sarkhanlou F, Saeedi M, Janbabai G, Nikfar S, Morteza-Semnani K, Zaboli P (2016). Comparative study of direct patient and drug Costs before and after the implica-tion of Healthcare Reform Program in Sari, Iran. J Maz Univ Med, 26:228-232.
3. Mojdehkar R, Hajinabi K, Jahangiri K, Riahi L (2019). Prioritizing influential financial indicators in equitable health financing based on the fairness benchmarking framework. FEYZ, 23:698-705.
4. Darvishi B, Behzadifar M, Ghanbari MK, et al (2021). Focus: Health Equity: Financial Protection Indexes and the Iranian Health Transformation Plan: A Systemat-ic Review. Yale J Biol Med, 94:465.
5. Mohammadzadeh Y, Dizaj JY, Mosa-deghrad AM, Kazemi A, Yusefzadeh H (2020). The impact of government subsi-dy programs on equity in health financ-ing. (In Press) 10.21203/rs.3.rs-87034/v1.
6. Jalali FS, Jafari A, Bayati M, Bastani P, Ravangard R (2019). Equity in healthcare financing: a case of Iran. Int J Equity Health, 18 (1): 92.
7. Rostampour M, Nosratnejad S (2020). A systematic review of equity in healthcare financing in low-and middle-income countries. Value Health Reg Issues, 21:133-140.
8. Karimi S, Bahman Ziari N (2013). Equity in financial indicators of the health in Iran during the third and fourth development programs. Health Inf Manage, 9:1113-22.
9. Emamgholipour S (2018). Equity in distribu-tion of financial burden of expenditure in the Iranian healthcare sector. Islam Econ Bank, 7:131-147.
10. Mosadeghrad AM (2019). Health strength-ening plan, a supplement to Iran health transformation plan: letter to the editor. Tehran Univ Medical J, 77:537-538.
11. Mousavi SM, Sadeghifar J (2016). Universal health coverage in Iran. Lancet Glob Health,4:305-306.
12. Mehrara M, Fazaeli AA (2010). Health fi-nance equity in Iran: an analysis of household survey data (1382-1386). J Health Adm, 13:51-62.
13. Sen A (2002). Why health equity?. Health Econ, 11(8): 659–666.
14. Bagheri Lankaran K, Khankeh HR, Zarei N, Fararouei M, Saboori Z, Joulaei H (2017). Toward equity under health system re-form; a systematic review. Shiraz E Med J, 18(11):e57724.
15. Peikanpour M, Esmaeli S, Yousefi N, Ary-aeinezhad A, Rasekh H (2018). A review of achievements and challenges of Iran’s health transformation plan. Payesh, 17:481-494.
16. Asefzadeh S, Alijanzadeh M, Peyravian F (2014). Out of pocket expenditures for outpatient clinics in teaching hospitals. Payesh, 13(3):267-76.
17. Alipour V, Zandian H, Yazdi-Feyzabadi V, Avesta L, Moghadam TZ (2021). Eco-nomic burden of cardiovascular diseases before and after Iran’s health transfor-mation plan: evidence from a referral hospital of Iran. Cost Eff Resour Alloc, 19:1-10.
18. Rad EH, Yazdi-Feyzabad V, Yousefzadeh-Chabok S, Afkar A, Naghibzadeh A (2017). Pros and cons of the health trans-formation program in Iran: evidence from financial outcomes at the house-hold level. Epidemiol Health, 39, https://doi.org/10.4178/epih.e2017029
19. Piroozi B, Takian A, Moradi G, Amerzadeh M, Safari H, Faraji O (2018). The effect of Iran's health transformation plan on utili-zation of specialized outpatient visit ser-vices: An interrupted time series. Med J Is-lam Repub Iran, 32:121.
20. Rezaei S, Woldemichael A, Ebrahimi M, Ahmadi S (2020). Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect. J Egypt Public Health Assoc, 95(1):29.
21. Piroozi B, Moradi G, Esmail Nasab N, Ghasri H, Farshadi S, Farhadifar F (2016). Evaluating the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers: A case study in Kurdistan province between 2013-2015. Hayat, 22:245-254.
22. Zahed Pasha Y, Mouodi S, Ahmadpour Ka-cho M, Hajitabar Z, Jahangir T, Bijani A (2017). Comparing the Hospital Costs of the Neonates Admitted to NICU of Amirkola Children's Hospital Before and After the Implementation of the Health Sector Reform in Iran. Iran J Neonatol, 8:25-30.
23. Piroozi B, Rashidian A, Moradi G, Takian A, Ghasri H, Ghadimi T (2017). Out-of-pocket and informal payment before and after the health transformation plan in Iran: evidence from hospitals located in Kurdistan, Iran. Int J Health Policy Manag, 6(10):573-86.
24. Naghdi P, Mohammadi M, Jahangard MA, Yousefe A, Rafiee N (2017). The propor-tion of unmet costs considering inpa-tients billing of selected hospitals, after 2014 Health System reform implementa-tion in Isfahan Province. J Educ Health Promot, 6:32.
25. Emamgholipour S, Akbari Sari A, Geravandi S, Mazrae H (2017). Estimation of out-of-pocket and catastrophic expenditures among patients with cardiovascular dis-eases in Khuzestan. J Payavard Salamat, 11:297-307.
26. Ahmadnezhad E, Murphy A, Alvandi R, Abdi Z (2019). The impact of health re-form in Iran on catastrophic health ex-penditures: equity and policy implications. Int J Health Plan Manage, 34:e1833-e1845.
27. Abdi Z, Hsu J, Ahmadnezhad E, Majdzadeh R, Harirchi I (2020). An analysis of finan-cial protection before and after the Irani-an Health Transformation Plan. East Mediterr Health J, 26:1025-1033.
28. Na’emani F, Tofighi S, Yahyavi Dizaji J, Sa-faei Lari M, Noorizadeh P (2019). As-sessment of the Fairness in Financial Contribution Index in Iranian Health Sys-tem from 2007 to 2017. Iran J Health In-sur, 2:01-06.
29. Kheibari MJ, Esmaeili R, Kazemian M (2019). Impacts of health reform plan in Iran on health payments distributions and catastrophic expenditure. Iran J Public Health, 48:1861-69.
30. Arani AA, Atashbar T, Antoun J, Bossert T (2018). Iran’s health reform plan: measur-ing changes in equity indices. Iran J Public Health, 47:390-96.
31. Faradonb S, Arab M, Roodbari M, Re-zapoor A, Faradonbeh H, Azar F (2016). Catastrophic and impoverishing health expenditure in Tehran urban population. J Health Adm, 19 (63) :55-67.
32. Nemati E, Khezri A, Nosratnejad S (2020). The Study of Out-of-pocket Payment and the Exposure of Households with Catastrophic Health Expenditures Fol-lowing the Health Transformation Plan in Iran. Risk Manag Healthc Policy, 13:1677-85.
33. Yaghoubi M, Javadi M, Karimi S, Pirasteh V (2018). Costs of normal and caesarian section delivery before and after imple-mentation of the national health sector evolution plan in Iran from the perspec-tives of patients, health service providers and hospitals. J School Public Health Institute Public Health Res,16(2):114-25.
34. Kavosi Z, Ghodrati J, Yusefi A (2018). Comparison of paying out of pocket for aortic valve replacement (AVR) surgery before and after the implementation of healthcare reform in Shiraz Namazi Hos-pital in 2016. J Rafsanjan Univ Med Sci Health Serv, 17(7):657-68.
35. Maharlou HR, Barati O, Maher MH (2016). The Study of Inpatient Services Costs Provided to Cardiovascular Patients Re-ferred to Al-Zahra Heart Hospital in Shi-raz During 2ndHalf of 2013 and Com-pare to the Same Time After Iranian Health Transformation Plan Implementa-tion. J Healthc Manag, 7(2):31-8.
36. Moradi T, Naghdi S, Brown H, Ghiasvand H, Mobinizadeh M (2018). Decomposing inequality in financial protection situation in Iran after implementing the health re-form plan: What does the evidence show based on national survey of households' budget?. Int J Health Plan Manag, 33:652-661.
37. Piroozi B, Zarei B, Ghaderi B, et al (2019). Catastrophic health expenditure and its determinants in households with gastro-intestinal cancer patients: evidence from new health system reform in Iran. Int J Hum Rights Healthc, 12 (4): 249-257.
38. Barfar E, Pourreza A, Sharifi V, Sobhanian SMH, Akbari Sari A (2019). Catastrophic Health Expenditure in Households with Severe Mental Disorders Patients: Evi-dence after Iran's Health Transformation Plan. Health Scope, 8(2):e79700.
39. Kazemi-Karyani A, Woldemichael A, Soofi M, Matin BK, Soltani S, Dizaj JY (2020). Explaining Socioeconomic Inequality Dif-ferences in Catastrophic Health Expendi-ture between Urban and Rural Areas of Iran after Health Transformation Plan Implementation. Clinicoecon Outcomes Res, 12:669-681.
40. Khammarnia M, Setoodehzadeh F, Ansari-Moghaddam A, Barfar E, Peyvand M (2020). Household financial contribution to the health system after Iran's Health Transformation Plan. Rural Remote Health, 20:5495-5495.
41. Kazemi-Galougahi MH, Dadgar E, Kavosi Z, Majdzadeh R (2019). Increase of cata-strophic health expenditure while it does not have socio-economic anymore; find-ing from a district on Tehran after recent extensive health sector reform. BMC Health Serv Res, 19:1-12.
42. Yazdi-Feyzabadi V, Mehrolhassani MH, Darvishi A (2019). Measuring cata-strophic health expenditures and its ine-quality: evidence from Iran’s Health Transformation Program. Health Policy Plan, 34:316-325.
43. Atefi M, Raghfar H, Mousavi M, Safarzadeh E (2021). The Impact of implementation of Health Reformation Plan on Fair Fi-nancial Contribution in Iran using Pseu-do-Panel data. J Appl Econ Studies in Iran, 9(36):35-67.
2. Sarkhanlou F, Saeedi M, Janbabai G, Nikfar S, Morteza-Semnani K, Zaboli P (2016). Comparative study of direct patient and drug Costs before and after the implica-tion of Healthcare Reform Program in Sari, Iran. J Maz Univ Med, 26:228-232.
3. Mojdehkar R, Hajinabi K, Jahangiri K, Riahi L (2019). Prioritizing influential financial indicators in equitable health financing based on the fairness benchmarking framework. FEYZ, 23:698-705.
4. Darvishi B, Behzadifar M, Ghanbari MK, et al (2021). Focus: Health Equity: Financial Protection Indexes and the Iranian Health Transformation Plan: A Systemat-ic Review. Yale J Biol Med, 94:465.
5. Mohammadzadeh Y, Dizaj JY, Mosa-deghrad AM, Kazemi A, Yusefzadeh H (2020). The impact of government subsi-dy programs on equity in health financ-ing. (In Press) 10.21203/rs.3.rs-87034/v1.
6. Jalali FS, Jafari A, Bayati M, Bastani P, Ravangard R (2019). Equity in healthcare financing: a case of Iran. Int J Equity Health, 18 (1): 92.
7. Rostampour M, Nosratnejad S (2020). A systematic review of equity in healthcare financing in low-and middle-income countries. Value Health Reg Issues, 21:133-140.
8. Karimi S, Bahman Ziari N (2013). Equity in financial indicators of the health in Iran during the third and fourth development programs. Health Inf Manage, 9:1113-22.
9. Emamgholipour S (2018). Equity in distribu-tion of financial burden of expenditure in the Iranian healthcare sector. Islam Econ Bank, 7:131-147.
10. Mosadeghrad AM (2019). Health strength-ening plan, a supplement to Iran health transformation plan: letter to the editor. Tehran Univ Medical J, 77:537-538.
11. Mousavi SM, Sadeghifar J (2016). Universal health coverage in Iran. Lancet Glob Health,4:305-306.
12. Mehrara M, Fazaeli AA (2010). Health fi-nance equity in Iran: an analysis of household survey data (1382-1386). J Health Adm, 13:51-62.
13. Sen A (2002). Why health equity?. Health Econ, 11(8): 659–666.
14. Bagheri Lankaran K, Khankeh HR, Zarei N, Fararouei M, Saboori Z, Joulaei H (2017). Toward equity under health system re-form; a systematic review. Shiraz E Med J, 18(11):e57724.
15. Peikanpour M, Esmaeli S, Yousefi N, Ary-aeinezhad A, Rasekh H (2018). A review of achievements and challenges of Iran’s health transformation plan. Payesh, 17:481-494.
16. Asefzadeh S, Alijanzadeh M, Peyravian F (2014). Out of pocket expenditures for outpatient clinics in teaching hospitals. Payesh, 13(3):267-76.
17. Alipour V, Zandian H, Yazdi-Feyzabadi V, Avesta L, Moghadam TZ (2021). Eco-nomic burden of cardiovascular diseases before and after Iran’s health transfor-mation plan: evidence from a referral hospital of Iran. Cost Eff Resour Alloc, 19:1-10.
18. Rad EH, Yazdi-Feyzabad V, Yousefzadeh-Chabok S, Afkar A, Naghibzadeh A (2017). Pros and cons of the health trans-formation program in Iran: evidence from financial outcomes at the house-hold level. Epidemiol Health, 39, https://doi.org/10.4178/epih.e2017029
19. Piroozi B, Takian A, Moradi G, Amerzadeh M, Safari H, Faraji O (2018). The effect of Iran's health transformation plan on utili-zation of specialized outpatient visit ser-vices: An interrupted time series. Med J Is-lam Repub Iran, 32:121.
20. Rezaei S, Woldemichael A, Ebrahimi M, Ahmadi S (2020). Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect. J Egypt Public Health Assoc, 95(1):29.
21. Piroozi B, Moradi G, Esmail Nasab N, Ghasri H, Farshadi S, Farhadifar F (2016). Evaluating the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers: A case study in Kurdistan province between 2013-2015. Hayat, 22:245-254.
22. Zahed Pasha Y, Mouodi S, Ahmadpour Ka-cho M, Hajitabar Z, Jahangir T, Bijani A (2017). Comparing the Hospital Costs of the Neonates Admitted to NICU of Amirkola Children's Hospital Before and After the Implementation of the Health Sector Reform in Iran. Iran J Neonatol, 8:25-30.
23. Piroozi B, Rashidian A, Moradi G, Takian A, Ghasri H, Ghadimi T (2017). Out-of-pocket and informal payment before and after the health transformation plan in Iran: evidence from hospitals located in Kurdistan, Iran. Int J Health Policy Manag, 6(10):573-86.
24. Naghdi P, Mohammadi M, Jahangard MA, Yousefe A, Rafiee N (2017). The propor-tion of unmet costs considering inpa-tients billing of selected hospitals, after 2014 Health System reform implementa-tion in Isfahan Province. J Educ Health Promot, 6:32.
25. Emamgholipour S, Akbari Sari A, Geravandi S, Mazrae H (2017). Estimation of out-of-pocket and catastrophic expenditures among patients with cardiovascular dis-eases in Khuzestan. J Payavard Salamat, 11:297-307.
26. Ahmadnezhad E, Murphy A, Alvandi R, Abdi Z (2019). The impact of health re-form in Iran on catastrophic health ex-penditures: equity and policy implications. Int J Health Plan Manage, 34:e1833-e1845.
27. Abdi Z, Hsu J, Ahmadnezhad E, Majdzadeh R, Harirchi I (2020). An analysis of finan-cial protection before and after the Irani-an Health Transformation Plan. East Mediterr Health J, 26:1025-1033.
28. Na’emani F, Tofighi S, Yahyavi Dizaji J, Sa-faei Lari M, Noorizadeh P (2019). As-sessment of the Fairness in Financial Contribution Index in Iranian Health Sys-tem from 2007 to 2017. Iran J Health In-sur, 2:01-06.
29. Kheibari MJ, Esmaeili R, Kazemian M (2019). Impacts of health reform plan in Iran on health payments distributions and catastrophic expenditure. Iran J Public Health, 48:1861-69.
30. Arani AA, Atashbar T, Antoun J, Bossert T (2018). Iran’s health reform plan: measur-ing changes in equity indices. Iran J Public Health, 47:390-96.
31. Faradonb S, Arab M, Roodbari M, Re-zapoor A, Faradonbeh H, Azar F (2016). Catastrophic and impoverishing health expenditure in Tehran urban population. J Health Adm, 19 (63) :55-67.
32. Nemati E, Khezri A, Nosratnejad S (2020). The Study of Out-of-pocket Payment and the Exposure of Households with Catastrophic Health Expenditures Fol-lowing the Health Transformation Plan in Iran. Risk Manag Healthc Policy, 13:1677-85.
33. Yaghoubi M, Javadi M, Karimi S, Pirasteh V (2018). Costs of normal and caesarian section delivery before and after imple-mentation of the national health sector evolution plan in Iran from the perspec-tives of patients, health service providers and hospitals. J School Public Health Institute Public Health Res,16(2):114-25.
34. Kavosi Z, Ghodrati J, Yusefi A (2018). Comparison of paying out of pocket for aortic valve replacement (AVR) surgery before and after the implementation of healthcare reform in Shiraz Namazi Hos-pital in 2016. J Rafsanjan Univ Med Sci Health Serv, 17(7):657-68.
35. Maharlou HR, Barati O, Maher MH (2016). The Study of Inpatient Services Costs Provided to Cardiovascular Patients Re-ferred to Al-Zahra Heart Hospital in Shi-raz During 2ndHalf of 2013 and Com-pare to the Same Time After Iranian Health Transformation Plan Implementa-tion. J Healthc Manag, 7(2):31-8.
36. Moradi T, Naghdi S, Brown H, Ghiasvand H, Mobinizadeh M (2018). Decomposing inequality in financial protection situation in Iran after implementing the health re-form plan: What does the evidence show based on national survey of households' budget?. Int J Health Plan Manag, 33:652-661.
37. Piroozi B, Zarei B, Ghaderi B, et al (2019). Catastrophic health expenditure and its determinants in households with gastro-intestinal cancer patients: evidence from new health system reform in Iran. Int J Hum Rights Healthc, 12 (4): 249-257.
38. Barfar E, Pourreza A, Sharifi V, Sobhanian SMH, Akbari Sari A (2019). Catastrophic Health Expenditure in Households with Severe Mental Disorders Patients: Evi-dence after Iran's Health Transformation Plan. Health Scope, 8(2):e79700.
39. Kazemi-Karyani A, Woldemichael A, Soofi M, Matin BK, Soltani S, Dizaj JY (2020). Explaining Socioeconomic Inequality Dif-ferences in Catastrophic Health Expendi-ture between Urban and Rural Areas of Iran after Health Transformation Plan Implementation. Clinicoecon Outcomes Res, 12:669-681.
40. Khammarnia M, Setoodehzadeh F, Ansari-Moghaddam A, Barfar E, Peyvand M (2020). Household financial contribution to the health system after Iran's Health Transformation Plan. Rural Remote Health, 20:5495-5495.
41. Kazemi-Galougahi MH, Dadgar E, Kavosi Z, Majdzadeh R (2019). Increase of cata-strophic health expenditure while it does not have socio-economic anymore; find-ing from a district on Tehran after recent extensive health sector reform. BMC Health Serv Res, 19:1-12.
42. Yazdi-Feyzabadi V, Mehrolhassani MH, Darvishi A (2019). Measuring cata-strophic health expenditures and its ine-quality: evidence from Iran’s Health Transformation Program. Health Policy Plan, 34:316-325.
43. Atefi M, Raghfar H, Mousavi M, Safarzadeh E (2021). The Impact of implementation of Health Reformation Plan on Fair Fi-nancial Contribution in Iran using Pseu-do-Panel data. J Appl Econ Studies in Iran, 9(36):35-67.
| Files | ||
| Issue | Vol 52 No 9 (2023) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v52i9.13567 | |
| Keywords | ||
| Health transformation plan Equity Financing Out-of-pocket payment Catastrophic expenditure | ||
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How to Cite
1.
Bordbar S, Gholampoor H, Jalali FS, Delavari S. The Effect of Iran Health Transformation Plan on Equity in Health Financing: A Systematic Review. Iran J Public Health. 2023;52(9):1844-1854.
