Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 47 10 2018 10 06 1552 1557 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 2018 10 06 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.   https://ijph.tums.ac.ir/index.php/ijph/article/view/14919 https://ijph.tums.ac.ir/index.php/ijph/article/download/14919/6164