Assessing the Distribution of Household Financial Contribution to Health System: A Case Study of Iran.

BACKGROUND Throughout the world, financing the healthcare system through households' financial contribution is a challenging issue in evaluating performance of healthcare systems. The purpose of this paper is illustrating the consequences of Iranian household to health system financial contribution in terms of burden and incomes approaches. METHOD The Data derived from an annual survey by Statistics Center of Iran (SCI) on expenditure-income of 36,551 households in 2012 was used to analyze countrywide distribution indicators of households' medical expenses by measuring indices of Income and burden approaches based on World Health Organization (WHO) and World Bank recommended methodologies. RESULTS The fairness in financial contribution index was 0.85 and 0.82, and the income redistributive effect index was 0.54 and 0.3 in urban and rural areas, respectively. The fairness in financial contribution index was found 0.84 and 0.83 and the income redistributive effect index was 0.48 and 0.25 for households with and without medical insurance, respectively.The percentages of household with catastrophic health payments were 2.4% and 4% and the change in the number of household falling below the poverty line due to health system payments was 0.4% and 2% in urban and rural areas, respectively. The percentages of household with catastrophic health payments were 2.8% and 3% and the change in the number of household falling below the poverty line due to health system payments was 0.008 and 0.011 for households with and without medical insurance, respectively. CONCLUSION Distribution indicators of medical expenses were more favorable in urban areas compared to rural areas and Medical insurance has declined impoverishment risks and number of people suffered due to catastrophic health expenditure. In addition, the result showed that there are different approaches for analyzing the distribution of out of pocket payments which used to complement each other in respect of formulation and development policy making in health system.