Fairness in Household Financial Contribution to the Healthcare System; the Evidence of Iran from 2008 to 2018

Objective: The achievement of equity in health leads to health gains and financial risk protection and this issue was one of the important goals of Iran’s health transformation programm (HTP). The present study aimed to how the HTP achieved its objectives in terms of fair financial protection by assessing the Fair Financial Contribution Index (FFCI) in various households of urban and rural areas before (2008-2013) and after (2014-2018) the implementation of the HTP. Results: According to the sample analyzed, 207,980 and 212,249 of households lived in urban and rural areas, respectively. The worst fair contributions to health expenditure in urban (FFCI= 0.684) and rural areas (FFCI= 0.530) were occurred in 2010 and 2009, respectively. Otherwise, the best fair contributions for urban areas (FFCI=0.858) and rural areas (FFCI= 0.836) were made in 2011. Before the HTP implementation was began (between 2008 and 2013), FFCI witnessed minor changes from 0.834 in 2008 to 0.833 in 2013. Following the HTP implementation, the FFCI values in urban and rural population declined (worsened) from 0.842 to 0.836 and 0.816 to 0.809, respectively. Overall, FFCI has been improved during years after the implementation of HTP. Such that, the improvement was shown more in rural areas.