Impact Evaluation of Instability of Financial Resources in Health System Transformation Plan on Achieving Financial Protection in Universal Health Coverage

Document Type : Research Paper

Authors

Department of Health Economics, Faculty of Management and Economics, Tarbiat Modares University, Tehran, Iran.

Abstract

Universal health coverage is defined as the reception of health services by all individuals without fear of financial hardship. The goal of financial protection in universal health coverage is to ensure that direct payments for health by households (out-of-pocket expenses) are not catastrophic or impoverishing. The Health System Transformation Plan was implemented in Iran in 2014, fully aligned with the goal of financial protection in universal health coverage. However, the financing resources of this plan were not fully allocated in 2017, and the financial support to households decreased. This increased direct payments by households and the incidence of catastrophic health expenditure and impoverishing health expenditure for them in the coming years. This study examined the level of vulnerability of different groups of households with different socioeconomic characteristics due to the reduced support of this plan. The research method was the econometric strategy of policy impact evaluation by propensity score matching. The data used involved a household income and expenditure survey. Direct payments for health by households increased, especially in 2019, due to the decrease in financial support of this plan in 2017. Catastrophic health expenditure occurred mainly in low-income deciles in urban areas and middle-income deciles in rural areas. Besides, impoverishing health expenditure occurred more frequently among unemployed urban household heads, urban heads under 15 and over 64 years old, and rural female heads. Therefore, more vulnerable groups should be covered more by insurance in future health system policies.

Keywords

Main Subjects

References

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Iranian Economic Review
Volume 29, Issue 4
December 2025
Pages 1256-1288

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