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The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications

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  • Elham Ahmadnezhad
  • Adrianna Murphy
  • Rezvaneh Alvandi
  • Zhaleh Abdi

Abstract

Purpose In 2014, the Islamic Republic of Iran launched the Health Transformation Plan (HTP), with the goal of achieving universal health coverage (UHC) through improved financial protection and access to high‐quality health services among Iranian households. We aimed to investigate the impact of the HTP on the level and pattern of out‐of‐pocket (OOP) payments for health care. Methods Using data from two rounds (2013 and 2016) of the Iranian Statistics Centre's Household Expenditure and Income Survey (HEIS), collected before and after implementation of the HTP, we estimate changes in the level and drivers of OOP payments, and the prevalence, intensity, and distribution of catastrophic health expenditures (CHEs) among Iranian households. Findings Our results indicate that per capita OOP payments on health remained stable during the observed period, with the largest proportion of OOP payments spent on medicines. Using thresholds of 10% and 25% of total consumption, there was a slight increase in the prevalence of CHE. The prevalence of CHE increased from 3.76% to 3.82% at threshold of 25% of total consumption. Using 40% capacity to pay threshold, prevalence diminished modestly from 2.5% to 2.37% and the intensity decreased from 13.16% to 12.32%. At all thresholds, CHE were more concentrated among wealthier households. Conclusion These results suggest that while financial protection of the poor in Iran has improved due to the HTP, more work is needed to achieve UHC in Iran. For the next phase of health reforms, more emphasis should be placed on shifting away from OOP co‐payments for health financing to progressive prepayment mechanisms to facilitate better sharing of financial risks across population groups.

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  • Elham Ahmadnezhad & Adrianna Murphy & Rezvaneh Alvandi & Zhaleh Abdi, 2019. "The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1833-1845, October.
    • Handle: RePEc:bla:ijhplm:v:34:y:2019:i:4:p:e1833-e1845
    DOI: 10.1002/hpm.2900
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    References listed on IDEAS

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    1. Tayebeh Moradi & Seyran Naghdi & Heather Brown & Hesam Ghiasvand & Mohammadreza Mobinizadeh, 2018. "Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(3), pages 652-661, July.
    2. Ties Boerma & Patrick Eozenou & David Evans & Tim Evans & Marie-Paule Kieny & Adam Wagstaff, 2014. "Monitoring Progress towards Universal Health Coverage at Country and Global Levels," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-8, September.
    3. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan‐Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184, November.
    4. Somkotra, Tewarit & Lagrada, Leizel P., 2008. "Payments for health care and its effect on catastrophe and impoverishment: Experience from the transition to Universal Coverage in Thailand," Social Science & Medicine, Elsevier, vol. 67(12), pages 2027-2035, December.
    5. Priyanka Saksena & Justine Hsu & David B Evans, 2014. "Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-11, September.
    6. Ahmed Shoukry Rashad & Mesbah Fathy Sharaf, 2015. "Catastrophic Economic Consequences of Healthcare Payments: Effects on Poverty Estimates in Egypt, Jordan, and Palestine," Economies, MDPI, vol. 3(4), pages 1-19, November.
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    1. Masoud Behzadifar & Maryam Saran & Meysam Behzadifar & Mariano Martini & Nicola Luigi Bragazzi, 2021. "The ‘Health Transformation Plan’ in Iran: A policy to achieve universal health coverage in slums and informal settlement areas," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(2), pages 267-272, March.
    2. Hsu, Justine & Majdzadeh, Reza & Mills, Anne & Hanson, Kara, 2021. "A dominance approach to analyze the incidence of catastrophic health expenditures in Iran," Social Science & Medicine, Elsevier, vol. 285(C).

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