Out-of-pocket payments for health services in line with Universal Health Coverage in 2017 in Iran

According to the concept of Universal Health Coverage (UHC), health services include health promotion, prevention, treatment, rehabilitation and palliative services. The aim of this study was to investigate the contribution of each health service to out-of-pocket payments (OOP) and financial protection.

In this study, OOP were extracted from the 1396 (2017) national household income expenditure survey with a sample of 37866 households. Catastrophic health expenditures were defined as health expenses greater than 10 percent of a household's expenditures and impoverishing health expenditures were calculated using WHO method. Binary logistic regression test was used to examine the effect of payment for different health services on households having catastrophic and impoverishing health expenditures.

According to the survey questionnaire, health services could be classified into 4 categories of treatment, prevention, diagnosis and rehabilitation services, and questions about promotion and palliative services were not been asked specifically. Treatment services accounted for the largest out-of-pocket share with 81%. In urban households, Per capita OOP payments in all aspects of health services were higher than rural households. Treatment services alone were alone responsible 75% and 89% of households suffering from catastrophic and impoverishing health expeditures respectively. OOP payments for all types of health services had a significant effect on a household's exposure to catastrophic and impoverishing health expenditures.

Focusing and implementing interventions to reduce out-of-pocket payments for Treatment services can significantly improve financial protection indicators, paving the way to the achievement of UHC in Iran.