Background: The health transformation plan was implemented in Iran with eight service packages in 2014. However, it has faced various problems and barriers since no pilot programs were launched.
Objectives: The present study aimed to investigate the challenges of the out of pocket payment in the health system of Iran.
Methods: The required data for this applied qualitative study were collected through semi-structured interviews with 30 policymakers and planners of the health system of Iran in 2020. It must be noted that the participants were selected using the purposeful sampling method. The obtained data were entered into MAXQDA software (version 10) and analyzed through the content analysis approach.
Results: The data analysis resulted in five themes: 1) weakness in the structure of health expenditure management, 2) weakness in the structure of policy and plan development, 3) low effectiveness and efficiency of the health system, 4) lack of opportunities to identify the challenges facing the Ministry of Health, 5) consequences of the program. They were categorized into 12 concepts and 79 sub-themes, and the challenges were extracted from them.
Conclusion: By identification of the opportunities and challenges of the out-of-pocket payment, the results of this study can provide a suitable framework for observation and evaluation of the payment reduction program in the health system of Iran. Moreover, the findings offer good suggestions for policymakers and planners in different stages of the program.
- Schwarz J, Wyss K, Gulyamova ZM, Sharipov S. Out-of-pocket expenditures for primary health care in Tajikistan: a time-trend analysis. BMC Health Serv Res. 2013;13:103. doi: 10.1186/1472-6963-13-103. [PubMed: 23505990].
- Semnani S, Keshtkar AA. Assessing of equality on health care cost in Gorgan population laboratory study. J Gorgan Uni Med Sci. 2004;5(12):53-9.
- Roy K, Howard DH. Equity in out-of-pocket payments for hospital care: evidence from India. Health Policy. 2007;80(2):297-307. doi: 10.1016/j.healthpol.2006.03.012 [PubMed: 16678296].
- OliaeeManesh AR, Abolhallag M, Zangene M, Zakeri MR, Rashidian A, Kazemian M, et al. Report of National Health Accounts Islamic Republic of Iran- 2008. In: Office of Technology Assessment SatH, Department of Treatment, Ministry of Health and Medical Education, editor. Tehran: Sarnevesht Sazan; 2013.
- Shi L, Xie Y, Liu J, Kissinger P, Khan M. Is out-of-pocket cost a barrier to receiving repeat tests for chlamydia and gonorrhoea? Int J STD AIDS. 2013;24(4):301-6. doi: 10.1177/0956462412472821. [PubMed: 23970662].
- Delavande A, Hurd MD, Martorell P, Langa KM. Dementia and outof- pocket spending on health care services. Alzheimers Dement. 2013;9(1):19-29. doi: 10.1016/j.jalz.2011.11.003. [PubMed: 23154049].
- Chaudhuri A, Roy K. Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992–2002. Health Policy. 2008;88(1):38-48. doi: 10.1016/j.healthpol.2008.02.014. [PubMed: 18423775].
- World Health Organization. Health in 2015: from MDGs, Millennium Development Goals to SDGs. Switzerland: World Health Organization. 2015.
- Hossein Z, Gerard A. Trends in cost sharing among selected high income countries -- 2000-2010. Health Policy. 2013;112(1-2):35–44. doi: 10.1016/j.healthpol.2013.05.020. [PubMed: 23809913].
- Esfandiar, M., Rasi, V., Khodamoradi A. Health Transformation Plan in Stably Pathway. 1st Edition, Tehran: Research Institue of Iran, Social Security Organization; 2016.
- World Development Indicators: World Development Indicators (WDI) is the World Bank’s Premier Compilation Of Cross-Country Comparable Data On Development. The World Bank. Available at: URL: http://wdi.worldbank.org; 2016.
- Correa-Burrows P. Out-Of-Pocket Health Care Spending by the Chronically Ill in Chile. Procedia Economics and Finance. 2012;1:88-97.
- Ibrahimipour H, Maleki MR, Brown R, Gohari M, Karimi I, Dehnavieh R. A qualitative study of the difficulties in reaching sustainable universal health insurance coverage in Iran. Health Policy Plan. 2011;26(6):485-95. doi: 10.1093/heapol/czq084. [PubMed: 21303879].
- The Islamic Republic of Iran's Fourth Five-Year Development Plan. 2007-2011.
- The Islamic Republic of Iran's Fifth Five-year Development Plan. 2011-2015.
- Davari M. Economic challenges of Iran health system in Iran. Manag Health Inf. 2010;8:915-8.
- Baird K. High out-of-pocket medical spending among the poor and elderly in nine developed countries. Health Serv Res. 2016;51(4):1467–8. doi: 10.1111/1475-6773.12444. [PubMed: 26800220].
- Palladino R, Lee JT, Hone T, Filippidis FT, Millett C. The great recession and increased cost sharing in European health systems. Health Aff (Millwood). 2016;35(7):1204-13. doi: 10.1377/hlthaff.2015.1170. [PubMed: 27385235].
- Tambor M, Pavlova M, Woch P, Groot W. Diversity and dynamics of patient cost-sharing for physicians’ and hospital services in the 27 European Union countries. Eur J Pub Health. 2011;21(5):585–90. doi: 10.1093/eurpub/ckq139. [PubMed: 20884659]
- NeamatBakhsh M. The Opportunities and Challenges of the Ministry of Health and Medical Education for Improvement of Healthcare System. J Edu Med Sci. 2015;15:64-6.
- Keyvanara M, Karimi S, Khorasani E, Jafarian jazi M. Challenges Resulting from Healthcare Induced Demand: A Qualitative Study. Health Inf Manage. 2013;10(4):548.
- Doshmangir L, Rashidian A, Sari AA. Unresolved issues in medical tariffs: Challenges and respective solutions to improve tariff system in Iranian health sectors. Hospital. 2011;10(4): Pe32-9.
- Doshmangir L, Rashidian A. The experience of implementing the board of trustees’ policy in teaching hospitals in iran: an example of health system decentralization. Int J Health Policy Manage. 2015;4(4):207-16. doi: 10.15171/ijhpm.2014.115. [PubMed: 25844379].
- Atun R, De Andrade LO, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Health-system reform and universal health coverage in Latin America. Lancet. 2015;385(9974):1230-47. doi: 10.1016/S0140-6736(14)61646-9. [PubMed: 25458725].
- Sajadi HS, Ehsani-Chimeh E, Majdzadeh R. Universal health coverage in Iran: Where we stand and how we can move forward. Med J Islam Repub Iran. 2019;33:9. doi: 10.34171/mjiri.33.9. [PubMed: 31086788].
- Karimi S, Bahman Ziari N. Justice in Iran's financial indicators in the interval between the implementation of the third and fourth plans development. Samt Information Management.2012;9:1113-22.
- Kheiri B., Goodarzi L, Meshkini A, Khaki A. On Treatment, National Conference on the Critique of the Performance of the Eleventh Government in the Field of Samet. Tehran: JCCNC. 2015; 1: 37- 46. http://jccnc.iums.ac.ir/ article-1-26-en.html.
- Mehrolhassani MH, Jafari Sirizi M, Sadat Poorhoseini SS, Yazdi Feyzabadi V. The Challenges of Implementing Family Physician and Rural Insurance Policies in Kerman Province, Iran: A Qualitative Study. Health Develop J. 2012;1(3):193-206.
- Azizi A, Abdolkhani R. Survey the effect of hospital information system on improving the performance of Razi Hospital in Ahvaz. Journal Gentashapir. 2011;4:185-190. doi: 3002013900504.pdf.
- Sajadi H, Hosseini M, Hehghani A, Khodayari R, Zandiyan H, Hosseini H. The Policy Analysis of Iran's Health Transformation Plan in Therapeutic Services. Hakim Health Sys Res. 2018;21(2):71-88.
- Nouri S, Riahi L, Hajinabi K, Jahangiri K. Resource allocation criteria for health care system regulation: a comprehensive review of the literature. J hospital. 2018;16(4):73-82.
- Khalajinia Z, Gaeeni M. Challenges in implementation of health care reform in the area of treatment qom city. Manage Strat Health Syst. 2018;3(3):212-24. doi: 10.18502/mshsj.v3i3.253.
- Milanifar A. Legal challenges in medical ethics. Iran J Med Ethic Hist Med. 2011;4(3):1-8.
- Nakhaei Z, Abdolreza Gharehbagh Z, Jalalmanesh S. A survey on nurses’ satisfaction concerning the health system reform plan in hospitals affiliated to Birjand university of medical sciences in 2016. J Rafsanjan Univ Med Sci. 2017;16(1):61-72.
- Farahani AJ, Samadinia H, Dopeykar N, Azarabadi M. Health sector evolution plan of iran: a challenge for military hospitals. J MilMed. 2018;20(1):1-2.
- Jamshidbeigi Y, Abbasi M. Assessment of nurses, patient satisfaction, patient attendants in educational hospitals in Ahvaz city health development plan in 2015. Journal of Clinical Nursing and Midwifery. 2017;6(1):9-18.