Inequality in Payments for Health Insurance in Iran: During the Study Period 2011-2017

Inequalities in the health system that are defined as the differences between individuals in the enjoyment of health and its facilities, is one of the determinants of health among individuals and groups. The purpose of this study was evaluate the inequality in payment of health insurance in Iran during 2011 to 2017.

The present descriptive-analytical study was designed and conducted as cross-sectional study in 2018 year, using the National Household Expenditure Survey data which is done annually by the Iranian Statistics Center. In the present study, inequality in payment of Iranian health insurance during 2011-2017 was measured. For this purpose, the average household expenditures for health insurance and average household expenditures were calculated, and by the Lorenz curves, the Gini coefficient of these expenditures was calculated. Then, in order to assess the fairness of insurance payments, the Kakwani index was calculated.

The average Gini index for health insurance payments between urban and rural households during the whole study period was 0.34 and 0.47, respectively. Kakwani index values were always positive for rural areas throughout the study period, while urban areas were negative for 2012-2014. In addition, the trend of average changes in the Kakwani index across the country declined from 2011 to 2013, indicating an uneven trend in insurance payments in those years. But in the years 2014-2016 the trend of these changes was incremental.

The findings of the present study showed that the equity status of Iranian households' insurance payments was not favorable especially in urban areas; and it is necessary to achieve equity in the payments of family health insurance, planners and policymakers while reviewing the redistribution of resources in the country's insurance sector by redistributing resources in urban areas, along with improving the quality of covered health services. Proper insurance provides adequate financial protection for Iranian households.