Equity in Out-of-Pocket Payments for Healthcare Service Delivery in Urban and Rural Households: Evidence from Iran

Background: Out-of-pocket payments for medical services may undermine access to and equity in healthcare financing. Objectives: The present study aimed determine the distribution of burden out-of-pocket among households Qazvin province, Iran. Methods: This descriptive-analytical was conducted on urban rural Iran during 2019 - 2020. Data were obtained from Statistics Center (2019 2020). optimal sample size calculated be 992 households, selected via three-stage random cluster sampling. collected using a valid questionnaire face-to-face interviews with household owners. fair financial contribution index (FFCI), concentration index, Kakwani estimated Stata software. Results: parameters indicated that period (March 21, 2019-March 20, 2020), FFCI value 0.782 0.854, respectively. payment based income rank at 0.188 (P < 0.05) 0.031 households. In addition, -0.165 -0.84, Conclusions: According results, unequally distributed province These mostly concentrated 5th 7th deciles On other hand, regressive. To promote equity, health policymakers must run exemptions low-income groups also expand insurance coverage universal services.