How the Iranian Health Transformation Plan has changed inequality in healthcare financing in Iran?

Introduction: One of the major goals of health is providing a financing system without inequality; it has a significant impact on people’s access to healthcare. The present study aimed to investigate the inequality in households’ financial contribution to health expenditure before and after implementation of the Iranian Health Transformation Plan(HTP). Methods The present study is a secondary analysis of two waves of a national cross-sectional survey conducted in Iran. The data collected from the Households Income and Expenditure Survey(HIES) in 2013 and 2015. The research sample included 76,195 Iranian households. The inequality in households’ financial contributions to the health system(HFC) was assessed using the Gini coefficient, and the concentration index(CI). In addition, by using econometric modeling, the relationship between the implementation of the HTP and inequality in HFC was studied. The households’ financial included healthcare and health insurance prepayments. Results The Gini coefficient values were 0.67 and 0.65 in 2013 and 2015, respectively, which indicated a medium degree of inequality in HFC in both years. The CI values were 0.54 and 0.56 in 2013 and 2015, respectively, suggesting that inequalities in HFC were in favor of higher income quintiles in the years before and after the implementation of the HTP. Regression analysis showed Households with a female head, with an unemployed head, and with a head having income without a job were more contribution to financing health expenditure. The presence of a household member over the age of 65 was associated to higher level of HFC. The implementation of the HTP had a negative relationship with HFC. Discussion and conclusion The HTP, which aimed to provide an equal financing system, did not achieve the intended goal as enough. The implementation of HTP neglected factors at the individual and household levels, such as the presence of members older than age 60 in the family, a female household head, and unemployment; this resulted in a failure to reduce the inequality of HFC. We suggest that policy makers take into account individual factors and features of the household level to reduce inequality in HFC.