Determinants effect of health system reform in access to equity in health care financing in Iran

Abstract

Abstract: Introduction: A equitable financing system is one of the major goals of health systems that have a significant impact on access to health care. Objective: The purpose of this study was to investigate the status of equity in health care financing system of low and middle income countries and also the impact of implementation of health system transformation plan on equity in financing Iran. Method: The present study examines the status of equity in the financing system of low- and middle-income countries through a systematic review of databases and also calculates equity indices such as concentration index, Gini coefficient and Kakwani equity index in the Iranian health system and investigate the impact of implementing the health system reform on equity by econometric methods. Results: The results of the systematic review indicate system of financing through social and private insurance is equitable in low and middle income countries, and in contrast, the system of financing through direct payment out of pocket is unfair. Implementation of the the health system reform has had a minor impact on reducing household health costs and achieving equity, with a reduction of 0.01 per thousand Rials. Conclusion: Implementation of the the health system reform was not a good performance in equity. The reason for failure of health system reform in equity could be due to individual factors and household level characteristics such as presence of people over 65 years in household, unemployment and female head of household that these variables were ignored in health system reform in Iran.