National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran.
Centre for Global Chronic Conditions, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Int J Health Plann Manage. 2019 Oct;34(4):e1833-e1845. doi: 10.1002/hpm.2900. Epub 2019 Aug 27.
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.
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.
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.
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.
2014 年，伊朗伊斯兰共和国启动了卫生转型计划（HTP），旨在通过改善伊朗家庭的财务保障和获得高质量卫生服务的机会，实现全民健康覆盖（UHC）。我们旨在调查 HTP 对医疗保健自付费用（OOP）水平和模式的影响。
利用伊朗统计中心家庭支出和收入调查（HEIS）两轮（2013 年和 2016 年）的数据，这些数据是在 HTP 实施前后收集的，我们估计了 OOP 支付的水平和驱动因素的变化，以及伊朗家庭灾难性卫生支出（CHE）的流行率、强度和分布。
我们的结果表明，在此期间，人均卫生保健自付费用保持稳定，最大比例的 OOP 支出用于药品。使用 10%和 25%总消费的阈值， CHE 的流行率略有上升。在 25%总消费的阈值下， CHE 的流行率从 3.76%上升到 3.82%。使用 40%支付能力的阈值，患病率从 2.5%下降到 2.37%，强度从 13.16%下降到 12.32%。在所有阈值下， CHE 更多地集中在富裕家庭。
这些结果表明，尽管 HTP 改善了伊朗贫困人口的财务保障，但伊朗实现全民健康覆盖仍需更多努力。对于下一个卫生改革阶段，应更加重视从卫生筹资的 OOP 共付转向渐进式预付款机制，以促进在人群中更好地分担财务风险。
