Prioritizing influential financial indicators in equitable health financing based on the fairness benchmarking framework

Choosing the right tool for assessing inequalities of the distribution and allocation of health financial resources is one of the major challenges in health financing. The Fairness Benchmarks are the comprehensive policy tools for evaluation of fairness in the health system which includes Financial Barriers to Equitable Access, Equitable Financing, Administrative Efficiency, and Accountability. This study aimed to determine the most influential financial indicators on the distribution and allocation of health resources based on the fairness benchmarking framework.

The present descriptive-analytic study was conducted in 2019. Fifty health system financial indicators were selected from three sources: WHO, the Equity and Human Rights Commission, and the United State Agency of International Development and were compared with the national health and health equity indicators. After experts' accreditation, 15 financial indicators were selected and by survey among 206 experts from 31 provinces and using the confirmatory factor analysis, the effect of each indicator on the distribution and allocation of financial resources were evaluated.

Factor analysis showed that the ratio of out of pocket to total health expenditures and the share of health expenditure as percent of GDP in equitable financing, the need-based health resource allocation, in accountability, and the health insurance coverage based on vulnerability, in financial barriers to equitable access were the most influential indicators.

Health policy makers can be used indicators to assess inequalities in the allocation and distribution of financial resources, based on fairness benchmarks, to assess and determine the ethical priorities of reform in health financing.