Original Research

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


Mohammad Khammarnia1 PhD, Assistant Professor of Health Care Management

Fatemeh Setoodehzadeh2 PhD, Assistant Professor of Health Policy

Alireza Ansari-Moghaddam3 PhD, Professor of Epidemiology

Eshagh Barfar4 PhD, Assistant Professor of Health Economics *

Mehdi Zanganeh Baygi5 MD, PhD, Assistant Professor of Health Care Management

Mostafa Peyvand6 BSc, MSc Student of Epidemiology


1, 2, 3, 4, 5, 6 Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

ACCEPTED: 1 November 2019

early abstract:

Introduction: Iran's Health Transformation Plan (HTP) has been implemented from 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 multi-stage sampling. Data were collected using the World Health Survey (WHS) questionnaire. The questionnaire was designed by World Health Organization in 2003 for assessing health systems performance. Two main indicators of equity in health were measured, including the percentage of households facing Catastrophic Health Expenditures (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 in SPSS-22.

Results: The results showed that 484 (20.2%) of the households faced CHE after HTP. In addition, 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 over age 65 (P=0.001) and having members with disabilities and in need of care (P=0.001). There were also 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.

Conclusions: 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.