The impact of government subsidy programs on equity in health financing.

BACKGROUND: Iran government implemented the targeted subsidy plan in December 2010 to reduce energy consumption and inequality. In addition, the Health Transformation Plan was implemented by the Ministry of Health to reduce out-of-pocket payments. This study aimed to examine the impact of these two government subsidy programs on equity in health financing. METHOD: In this study, data on 528,046 households were collected using household surveys during 14 years (2007-2020). The Fairness in Financial Contribution index and Catastrophic Health Expenditures index were calculated. Also, a Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of the two mentioned policies and other socioeconomic characteristics of households on their exposure to Catastrophic Health Expenditures. RESULTS: The FFC index was 0.829 and 0.795 respectively in 2007 and 2020. The trend analysis did not show significant changes in the FFC index between 2007 and 2020. TSP and HTP implementations do not reduce households' exposure to CHE significantly. Crowded households with more elder people, belonging to low-income deciles, without houses, and living in rural areas and deprived provinces, are more likely to be at risk of CHE. Health insurance coverage did not protect households from CHE. Highly educated and employed households were exposed to less CHE. CONCLUSION: The government subsidy programs have not been effective in improving FFC and reducing CHE indices. None of them has been able to realize the goal of the 6th National Development Plan of reducing CHE to 1%. The government should devise support packages for target households (households with more elderly people, lower incomes, without private houses, crowded, rural, and inhabited in deprived provinces), so they can protect households against CHE. Modifying and improving the quality of insurance coverage is strongly recommended due to its inefficiency.

Household financial contribution to the health system after Iran's Health Transformation Plan.

INTRODUCTION: Iran's Health Transformation Plan (HTP) was implemented in 2014 to decrease household expenditures. The present study seeks to measure the household financial contribution to healthcare expenditures in Sistan-Baluchistan Province after the implementation of HTP. METHODS: A household survey was conducted in 2017 in Sistan-Baluchistan Province. The province is the most remote and poorest in the country and this poverty has extended to most of its main health indicators as well. About 2400 households were selected as the study samples using multistage sampling. Data were collected using the World Health Survey questionnaire. The questionnaire was designed by WHO in 2003 for assessing health system performance. Two main indicators of equity in health were measured: the percentage of households facing catastrophic health expenditure (CHE) and the Fair Financial Contribution Index (FFCI). The multiple adjusted logistic regression model was used to study the likelihood of facing CHE and to calculate the adjusted odds ratios (OR) using the model coefficients. Data were then analyzed the Statistical Package for the Social Sciences. RESULTS: The results showed that 484 (20.2%) of the households faced CHE after implementation of the HTP. The FFCI was approximately 0.7 across the province. Statistically significant relationships were observed between the chances of facing CHE and variables including place of residence (p=0.010), having members aged more than 65 years (p=0.005) and having members with disabilities and in need of care (p=0.001). There were statistically significant relationships between the chance of facing CHE and variables related to the use of health services, including the use of dental (OR=5.212), rehabilitation (OR=2.471), diagnostic and laboratory (OR=3.637), and inpatient (OR=2.511) services. CONCLUSION: Despite the implementation of HTP, a high percentage of the households faced CHE. The authorities should pay more attention to low-income and remote regions of the country; in addition, the HTP should financially cover outpatient healthcare services in an adequate manner.

Fairness in household financial contribution to the Iran's healthcare system from 2008 to 2018.

OBJECTIVE: Enhancing financial protection in health is one of the main goals of Iran's health transformation program (HTP), a recent reform conducted in early 2014. This study aimed to measure financial protection using the fair financial contribution index (FFCI) in urban and rural areas before (2008-2013) and after (2014-2018) the HTP implementation. Using a retrospective study on annual national cross-sectional surveys of households' income and expenditure, FFCI was measured. The total sample sizes for urban and rural areas from 2008 to 2018 were 207,980 and 212,249 households, respectively. RESULTS: The worst fair contributions to health expenditure in urban (FFCI = 0.684) and rural areas (FFCI = 0.530) were related to 2010 and 2009, respectively. Otherwise, the best fair contributions for urban (FFCI = 0.858) and rural (FFCI = 0.836) areas were made in 2011. Before the HTP implementation began, FFCI showed minor changes from 0.834 in 2008 to 0.833 in 2013. Following the HTP implementation, the FFCI values in urban and rural populations declined (worsened) from 0.842 to 0.836 and 0.816 to 0.809, respectively.On average more fair financial contributions had been made following five years after the HTP, especially in rural areas, but less than that expected in upstream documents (as determined 0.9).

Household financial contribution to the health System in Shiraz, Iran in 2012.

BACKGROUND: One common challenge to social systems is achieving equity in financial contributions and preventing financial loss. Because of the large and unpredictable nature of some costs, achieving this goal in the health system presents important and unique problems. The present study investigated the Household Financial Contributions (HFCs) to the health system. METHODS: The study investigated 800 households in Shiraz. The study sample size was selected using stratified sampling and cluster sampling in the urban and rural regions, respectively. The data was collected using the household section of the World Health Survey (WHS) questionnaire. Catastrophic health expenditures were calculated based on the ability of the household to pay and the reasons for the catastrophic health expenditures by a household were specified using logistic regression. RESULTS: The results showed that the fairness financial contribution index was 0.6 and that 14.2% of households were faced with catastrophic health expenditures. Logistic regression analysis revealed that household economic status, the basic and supplementary insurance status of the head of the household, existence of individuals in the household who require chronic medical care, use of dental and hospital care, rural location of residences, frequency of use of outpatient services, and Out-of-Pocket (OOP) payment for physician visits were effective factors for determining the likelihood of experiencing catastrophic health expenditure. CONCLUSION: It appears that the current method of health financing in Iran does not adequately protect households against catastrophic health expenditure. Consequently, it is essential to reform healthcare financing.