To what extent has the Iranian Health Transformation Plan addressed inequality in healthcare financing in Iran?
Equity in healthcare financing
Financing system
Health financing system
Iran
Journal
International journal for equity in health
ISSN: 1475-9276
Titre abrégé: Int J Equity Health
Pays: England
ID NLM: 101147692
Informations de publication
Date de publication:
06 04 2023
06 04 2023
Historique:
received:
19
02
2022
accepted:
31
03
2023
medline:
10
4
2023
entrez:
6
4
2023
pubmed:
7
4
2023
Statut:
epublish
Résumé
One of the major goals of health systems is providing a financing strategy without inequality; this has a significant impact on people's access to healthcare. The present study aimed to investigate the inequality in households' financial contribution (HFC) to health expenditure both before and after the implementation of the Iranian Health Transformation Plan (HTP) in 2014. This study is a secondary analysis of two waves of a national survey conducted in Iran. The data were collected from the Households Income and Expenditure Survey in 2013 and 2015. The research sample included 76,195 Iranian households. The inequality in households' financial contributions to the health system was assessed using the Gini coefficient, and the concentration index (CI). In addition, by using econometric modeling, the relationship between the implementation of the HTP and inequality in HFC was studied. The households' financial contribution included healthcare and health insurance prepayments. The Gini coefficient values were 0.67 and 0.65 in 2013 and 2015, respectively, indicating a medium degree of inequality in HFC in both years. The CI values were 0.54 and 0.56 in 2013 and 2015, respectively, suggesting that inequalities in HFC were in favor of higher income quintiles in the years before and after the implementation of the HTP. Regression analysis showed that households with a female head, with an unemployed head, or with a head having income without a job were contributing more to financing health expenditure. The presence of a household member over the age of 65 was associated with a higher level of HFC. The implementation of the HTP had a negative relationship with the HFC. The HTP, aiming to address inequality in the financing system, did not achieve the intended goal as expected. The implementation of the HTP neglected certain factors at the household level, such as the presence of family members older than the age of 65, a female household head, and unemployment. This resulted in a failure to reduce the inequality of the HFC. We suggest that, in the future, policymakers take into account factors at the household level to reduce inequality in the HFC.
Sections du résumé
BACKGROUND
One of the major goals of health systems is providing a financing strategy without inequality; this has a significant impact on people's access to healthcare. The present study aimed to investigate the inequality in households' financial contribution (HFC) to health expenditure both before and after the implementation of the Iranian Health Transformation Plan (HTP) in 2014.
METHODS
This study is a secondary analysis of two waves of a national survey conducted in Iran. The data were collected from the Households Income and Expenditure Survey in 2013 and 2015. The research sample included 76,195 Iranian households. The inequality in households' financial contributions to the health system was assessed using the Gini coefficient, and the concentration index (CI). In addition, by using econometric modeling, the relationship between the implementation of the HTP and inequality in HFC was studied. The households' financial contribution included healthcare and health insurance prepayments.
RESULTS
The Gini coefficient values were 0.67 and 0.65 in 2013 and 2015, respectively, indicating a medium degree of inequality in HFC in both years. The CI values were 0.54 and 0.56 in 2013 and 2015, respectively, suggesting that inequalities in HFC were in favor of higher income quintiles in the years before and after the implementation of the HTP. Regression analysis showed that households with a female head, with an unemployed head, or with a head having income without a job were contributing more to financing health expenditure. The presence of a household member over the age of 65 was associated with a higher level of HFC. The implementation of the HTP had a negative relationship with the HFC.
CONCLUSION
The HTP, aiming to address inequality in the financing system, did not achieve the intended goal as expected. The implementation of the HTP neglected certain factors at the household level, such as the presence of family members older than the age of 65, a female household head, and unemployment. This resulted in a failure to reduce the inequality of the HFC. We suggest that, in the future, policymakers take into account factors at the household level to reduce inequality in the HFC.
Identifiants
pubmed: 37024883
doi: 10.1186/s12939-023-01880-z
pii: 10.1186/s12939-023-01880-z
pmc: PMC10080967
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
62Informations de copyright
© 2023. The Author(s).
Références
Health Policy Plan. 2018 Dec 1;33(10):1065-1072
pubmed: 30535054
Soc Sci Med. 2008 Jun;66(11):2308-20
pubmed: 18314242
Soc Sci Med. 1999 Nov;49(10):1349-56
pubmed: 10509825
East Mediterr Health J. 2020 Sep 24;26(9):1025-1033
pubmed: 33047793
Health Econ. 2004 Jul;13(7):629-47
pubmed: 15259043
Bull World Health Organ. 2010 Jun;88(6):402
pubmed: 20539847
Bull World Health Organ. 2013 Aug 1;91(8):602-11
pubmed: 23940408
Rural Remote Health. 2020 Feb;20(1):5495
pubmed: 32069064
Int J Health Plann Manage. 2019 Oct;34(4):e1833-e1845
pubmed: 31452274
Fam Med. 2005 Jul-Aug;37(7):502-5
pubmed: 15988644
Int J Health Plann Manage. 2011 Jul-Sep;26(3):e121-137
pubmed: 20669188
Med J Islam Repub Iran. 2020 Aug 24;34:104
pubmed: 33315996
Soc Sci Med. 2006 Feb;62(4):858-65
pubmed: 16099574
J Med Liban. 2001 Jan-Feb;49(1):22-4
pubmed: 11910962
Lancet. 2016 Jan 2;387(10013):29-30
pubmed: 26766344
Yale J Biol Med. 2021 Sep 30;94(3):465-476
pubmed: 34602884
Int J Health Policy Manag. 2017 Feb 11;6(10):573-586
pubmed: 28949473
Int J Health Policy Manag. 2015 Aug 31;4(10):637-40
pubmed: 26673172
Epidemiol Health. 2017 Jul 18;39:e2017029
pubmed: 28728347
Health Policy Plan. 2012 Mar;27 Suppl 1:i13-22
pubmed: 22388496
Int J Equity Health. 2014 May 27;13:42
pubmed: 24885492
Int J Equity Health. 2003 Oct 9;2(1):8
pubmed: 14609435