Fiscal Space Assessment: A Missing Link in Financing Management of Iran’s Health System

Fiscal Space Assessment: A Missing Link in Financing Management of Iran’s Health System Nader Jahanmehr1,2, Soheila Damiri3*, Reza Goudarzi4, Zhaleh Abdi5 1 School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 4 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 5 National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran Abstract Introduction: The government’s ability to allocate additional resources to the health sector depends on the country’s macroeconomic condition. The concept of fiscal space helps put health in the broader context of the economic and financial environment. In this study, we explored the fundamentals of the concept of fiscal space for health and provided a brief overview of the different methods for the expansion of fiscal space for health in Iran. Methods: This review study, by using reports and articles published in internal and external databases, examines the theoretical foundations and different methods of fiscal space expansion in health generally and for Iran’s health system specifically. Results: Fiscal space for health is the availability of budgetary room that allows a government to provide resources for desired public purposes without impairing fiscal sustainability. This space can be generated by a variety of sources, which can broadly be categorized into five categories, including conducive macroeconomic conditions, a re-prioritization of health within the government budget, an increase in the health sector-specific resources, foreign aid, and an increase in the efficiency of existing government health outlays. Conclusion: The use of fiscal space analysis can help sustainable health financing and increase the alignment of health financing with the goals of the public financial management system. Keywords: Fiscal Space for Health; Sustainable Health Financing; Government Health Expenditure; Macroeconomy; Budget; Iran Please cite this article as follows: Jahanmehr N, Damiri S, Goudarzi R, Abdi Zh. Fiscal Space Assessment: A Missing Link in Financing Management of the Iran's Health System. Hakim Health Sys Res. 2020; 22(4): 337-348.   *Corresponding Author: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Enghelab Sq., Tehran, Iran. Tel: +98-9174256058, Email: [email protected]