Assessment of the Fairness in Financial Contribution Index in Iranian Health System from 2007 to 2017

Fairness in financial contribution is a fundamental objective for the health systems, which can improve access to health care services and health outcomes. Due to the importance of this issue, the current study aimed at assessing the fairness in financial contribution index (FFCI) in Iranian Health System from 2007 to 2017.

The current retrospective and cross-sectional study was conducted based on the annual income-expenditure survey of household data provided by the Statistics Center of Iran, from 2007 to 2017. The Statistics Center of Iran used a three-step clustered random method in the current study. The Fairness in Financial Contribution Index (FFCI) was calculated based on the formula presented by the World Health Organization (WHO) and using Excel software.

The findings of the current study showed that the FFC index for the whole study period on average was 0.84, 0.82 and 0.83, in urban, rural and total country, respectively. In addition, in 2009 and 2010, the FFC index declined in rural and urban areas and across the country. In 2011, both in rural and urban areas, tangible incremental changes were observed in the FFC index. The FFC index dropped from 2012-2014, and in 2016 it remained unchanged compared to 2015. In 2017, the FFC index had a significant increase, and reached 0.86 for the country.

According to the current study results, the policies adopted in the health sector from 2007 to 2017 including the development of treatment insurance, the economic reform plan (2009), and the health reform plan (2014) failed to achieve the goals of the National Development Plan on Financing Justice In the health system (FFCI = 0.9), there was a significant difference, especially in rural areas, with the specified target. Therefore, the health system requires attention and specified planning by government and policymakers to promote this index.