Abstract
IntroductionReducing inequalities in health care is one of the main challenges in all countries. In Iran as in other oil-exporting upper middle income countries, we expected to witness fewer inequalities especially in the health sector with the increase in governmental revenues.MethodsThis study presents an inequalities assessment of health care expenditures in Iran. We used data from the Household Income and Expenditure Survey (HIES) in Iran from 1984–2010. The analysis included 308,735 urban and 342,532 rural households.ResultsThe results suggest heightened inequality in health care expenditures in Iran over the past three decades, including an increase in the gap between urban and rural areas. Furthermore, inflation has affected the poor more than the rich. The Kakwani progressivity index in all years is positive, averaging 0.436 in rural and 0.470 in urban areas during the time period of analysis. Compared to inequality in income distribution over the last 30 years, health expenditures continuously show more inequality and progressivity over the same period of time.ConclusionsAccording to the result of our study, during this period Iran introduced four National Development Plans (NDPs); however, the NDPs failed to provide sustainable strategies for reducing inequalities in health care expenditures. Policies that protect vulnerable groups should be prioritized.
Highlights
Reducing inequalities in health care is one of the main challenges in all countries
This paper provides a descriptive account of inequality in health care expenditures in Iran from 1984 to 2010; our findings are similar to other findings in different periods and policy areas
To understand the impact of National Development Plans (NDPs) on health expenditures of households we considered indicators of inequality (Gini coefficient) and out-of-pocket progressivity (Kakwani index)
Summary
Reducing inequalities in health care is one of the main challenges in all countries. In Iran as in other oil-exporting upper middle income countries, we expected to witness fewer inequalities especially in the health sector with the increase in governmental revenues. Health care is a fundamental human right and one of the first responsibilities of a government is to establish effective and sustainable interventions to address inequality in health care [1] and protect low-income, vulnerable groups such as women and children, the elderly and the chronically ill [2]. Iran was expected to improve financial fairness and reduce economic barriers to accessing timely care for households facing catastrophic health events [16]. To this end, Iran rolled out its first five year economic, social, and cultural development plan (NDP) in 1989 [18]. Subsequent plans outlined the government’s intention to further invest in infrastructure and manage the macro-economy [19]
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